Provider Demographics
NPI:1558584557
Name:KROGER, JUDY L (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:L
Last Name:KROGER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6866 PRAIRE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-7251
Mailing Address - Country:US
Mailing Address - Phone:513-791-5990
Mailing Address - Fax:513-792-3308
Practice Address - Street 1:8035 HOSBROOK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2951
Practice Address - Country:US
Practice Address - Phone:513-791-5990
Practice Address - Fax:513-792-3308
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0004783101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR9303841Medicare ID - Type UnspecifiedCOUNSELING