Provider Demographics
NPI:1609117316
Name:KRUEGER, JESSICA A (MS, LPC, CSAC, CS-IT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MS, LPC, CSAC, CS-IT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:BIBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-0029
Mailing Address - Country:US
Mailing Address - Phone:608-355-4200
Mailing Address - Fax:608-355-4299
Practice Address - Street 1:505 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2183
Practice Address - Country:US
Practice Address - Phone:608-355-4200
Practice Address - Fax:608-355-4299
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16090-132101YA0400X
WI5661-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)