Provider Demographics
NPI:1518637198
Name:KRUSE, COURTNEY L (MS, SAC-IT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:L
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MS, SAC-IT
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:L
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N8921 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950-9490
Mailing Address - Country:US
Mailing Address - Phone:608-433-5051
Mailing Address - Fax:
Practice Address - Street 1:231 E STATE ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1346
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)