Provider Demographics
NPI:1912268715
Name:KRUEGER, RICKI GENE (MA, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:RICKI
Middle Name:GENE
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MA, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 IHDUHAPI RD
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:MN
Mailing Address - Zip Code:55357-2120
Mailing Address - Country:US
Mailing Address - Phone:763-479-4506
Mailing Address - Fax:763-479-4372
Practice Address - Street 1:3675 IHDUHAPI RD
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:MN
Practice Address - Zip Code:55357-2120
Practice Address - Country:US
Practice Address - Phone:763-479-4506
Practice Address - Fax:763-479-4372
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional