Provider Demographics
NPI:1245465194
Name:KRUGER, LISA ERIN (MS)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ERIN
Last Name:KRUGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 S WENTWORTH AVE
Mailing Address - Street 2:A
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2511
Mailing Address - Country:US
Mailing Address - Phone:414-520-3464
Mailing Address - Fax:414-615-0627
Practice Address - Street 1:2915 S WENTWORTH AVE
Practice Address - Street 2:A
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2511
Practice Address - Country:US
Practice Address - Phone:414-520-3464
Practice Address - Fax:414-615-0627
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional