Provider Demographics
NPI:1770675134
Name:KRUGER, ROGER (LIMHP)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:KRUGER
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2726
Mailing Address - Country:US
Mailing Address - Phone:402-614-6287
Mailing Address - Fax:
Practice Address - Street 1:19500 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2726
Practice Address - Country:US
Practice Address - Phone:402-614-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2985101YP1600X
NE943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral