Provider Demographics
NPI:1780493742
Name:KRUEGER, TIA LYNNE (LPC-IT)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:LYNNE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7647
Mailing Address - Country:US
Mailing Address - Phone:920-267-0661
Mailing Address - Fax:
Practice Address - Street 1:3103 SCENIC DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7647
Practice Address - Country:US
Practice Address - Phone:920-267-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8230226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional