Provider Demographics
NPI:1861815813
Name:KRUEGER, KARIN (MFT)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 E EXECUTIVE PARK DR STE D
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3558
Mailing Address - Country:US
Mailing Address - Phone:801-262-5154
Mailing Address - Fax:801-262-3433
Practice Address - Street 1:923 E EXECUTIVE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-3558
Practice Address - Country:US
Practice Address - Phone:801-262-5154
Practice Address - Fax:801-262-3433
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1146263902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist