Provider Demographics
NPI:1750522454
Name:KRUEGER, TRACIE ANN
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:ANN
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:126 PHOENIX AVE BLDG 2
Mailing Address - Street 2:THOM ANNE SULLIVAN CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4931
Mailing Address - Country:US
Mailing Address - Phone:978-453-8331
Mailing Address - Fax:978-453-9254
Practice Address - Street 1:126 PHOENIX AVE BLDG 2
Practice Address - Street 2:THOM ANNE SULLIVAN CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4931
Practice Address - Country:US
Practice Address - Phone:978-453-8331
Practice Address - Fax:978-453-9254
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist