Provider Demographics
NPI:1659008530
Name:KRUEGER, ELSIE (BCBA)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:
Other - Last Name:SAUCEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 BLENDON PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1807
Mailing Address - Country:US
Mailing Address - Phone:608-215-9785
Mailing Address - Fax:
Practice Address - Street 1:900 HORNET DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2310
Practice Address - Country:US
Practice Address - Phone:608-215-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst