Provider Demographics
NPI:1134229255
Name:KRUEGER, KATHLEEN MARY (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MS CCC SLP
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Other - Middle Name:
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Mailing Address - Street 1:1481 WEST 10TH STREET
Mailing Address - Street 2:DEPT 126
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2884
Mailing Address - Country:US
Mailing Address - Phone:317-988-2613
Mailing Address - Fax:317-988-2480
Practice Address - Street 1:2095 JENKINS COURT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1570
Practice Address - Country:US
Practice Address - Phone:317-843-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist