Provider Demographics
NPI:1598271926
Name:PEREZ KRUEGER, JENNIFER LEE (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:PEREZ KRUEGER
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:PO BOX 2506
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-2506
Mailing Address - Country:US
Mailing Address - Phone:218-454-0878
Mailing Address - Fax:
Practice Address - Street 1:7251 EXCELSIOR RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8477
Practice Address - Country:US
Practice Address - Phone:218-454-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN217941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical