Provider Demographics
NPI:1437600822
Name:KRUSE, JENNIFER (MS LAT ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MS LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4879 STATE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5775
Mailing Address - Country:US
Mailing Address - Phone:563-459-2342
Mailing Address - Fax:
Practice Address - Street 1:4879 STATE ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IA
Practice Address - Zip Code:52722-5775
Practice Address - Country:US
Practice Address - Phone:563-459-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0728202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer