Provider Demographics
NPI:1750314654
Name:KRUEGER, CELESTE (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9193 MOLT RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4436
Mailing Address - Country:US
Mailing Address - Phone:714-965-1781
Mailing Address - Fax:
Practice Address - Street 1:9193 MOLT RIVER CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4436
Practice Address - Country:US
Practice Address - Phone:714-965-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist