Provider Demographics
NPI:1124246483
Name:KRUEGER, SUSAN MELANIE (LAC, EAMP, LMP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MELANIE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LAC, EAMP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19710 209TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9377
Mailing Address - Country:US
Mailing Address - Phone:425-242-0954
Mailing Address - Fax:
Practice Address - Street 1:211 W HILL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1460
Practice Address - Country:US
Practice Address - Phone:480-839-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00024037172M00000X
173C00000X, 175M00000X
WAMA00024037225700000X
WAAC60121088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No175M00000XOther Service ProvidersMidwife, Lay
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist