Provider Demographics
NPI:1134658636
Name:KRUEGEL, JENNIFER RAE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:KRUEGEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2039
Mailing Address - Country:US
Mailing Address - Phone:330-945-5600
Mailing Address - Fax:
Practice Address - Street 1:2215 PICKLE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4223
Practice Address - Country:US
Practice Address - Phone:330-798-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid
OH1134658636Medicaid