Provider Demographics
NPI:1326355538
Name:KRUEGER, KATHY (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-0834
Mailing Address - Country:US
Mailing Address - Phone:408-241-0373
Mailing Address - Fax:209-830-0993
Practice Address - Street 1:902 CENTRAL AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3929
Practice Address - Country:US
Practice Address - Phone:408-241-0373
Practice Address - Fax:209-830-0998
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist