Provider Demographics
NPI:1467824102
Name:KRUER, KASAUNDRA LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KASAUNDRA
Middle Name:LEIGH
Last Name:KRUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 OCEAN CAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5889
Mailing Address - Country:US
Mailing Address - Phone:502-529-9953
Mailing Address - Fax:
Practice Address - Street 1:156 OCEAN CAY BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5889
Practice Address - Country:US
Practice Address - Phone:502-529-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical