Provider Demographics
NPI:1508081977
Name:KRUEGER, STEPHANIE A (LISW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 933132
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:330-724-5471
Mailing Address - Fax:
Practice Address - Street 1:1400 S ARLINGTON ST UNIT 38
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3771
Practice Address - Country:US
Practice Address - Phone:330-724-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.007042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional