Provider Demographics
NPI:1750698726
Name:KRUEGER, MARLA JEANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JEANNE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4711
Mailing Address - Country:US
Mailing Address - Phone:509-860-4133
Mailing Address - Fax:509-881-2633
Practice Address - Street 1:667 GRANT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7818
Practice Address - Country:US
Practice Address - Phone:509-860-4133
Practice Address - Fax:509-881-2633
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60157645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist