Provider Demographics
NPI:1629054093
Name:KROENING, JEFFREY T (MS LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:T
Last Name:KROENING
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0387
Mailing Address - Country:US
Mailing Address - Phone:920-458-5557
Mailing Address - Fax:920-458-2692
Practice Address - Street 1:3425 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1863
Practice Address - Country:US
Practice Address - Phone:920-458-5557
Practice Address - Fax:920-458-2692
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1017125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39544100Medicaid