Provider Demographics
NPI:1104432004
Name:KRUEGER, HANNAH N (PSY D)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:N
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 251377
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91225-1377
Mailing Address - Country:US
Mailing Address - Phone:818-230-7292
Mailing Address - Fax:818-660-2694
Practice Address - Street 1:1530 EAST CHEVY CHASE DRIVE
Practice Address - Street 2:SUITE #204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4139
Practice Address - Country:US
Practice Address - Phone:818-230-7292
Practice Address - Fax:818-660-2694
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32038103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty