Provider Demographics
NPI:1669586863
Name:KRUGER, JODELLE MARIE (MA, ATR-BC)
Entity type:Individual
Prefix:MISS
First Name:JODELLE
Middle Name:MARIE
Last Name:KRUGER
Suffix:
Gender:F
Credentials:MA, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1436
Mailing Address - Country:US
Mailing Address - Phone:717-233-1681
Mailing Address - Fax:717-234-8258
Practice Address - Street 1:3333 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1436
Practice Address - Country:US
Practice Address - Phone:717-233-1681
Practice Address - Fax:717-234-8258
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04-096 ATR-BC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor