Provider Demographics
NPI:1659682250
Name:KRUEGER, JESSICA JEAN (LLPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 HAMILTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1774
Mailing Address - Country:US
Mailing Address - Phone:517-420-1417
Mailing Address - Fax:
Practice Address - Street 1:2160 HAMILTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1774
Practice Address - Country:US
Practice Address - Phone:517-420-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional