Provider Demographics
NPI:1255725891
Name:KRUGER, JENNIFER MARIKO (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIKO
Last Name:KRUGER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIKO
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:3648 34TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1610
Mailing Address - Country:US
Mailing Address - Phone:619-318-6210
Mailing Address - Fax:
Practice Address - Street 1:3648 34TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1610
Practice Address - Country:US
Practice Address - Phone:619-318-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-21
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60443491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health