Provider Demographics
NPI:1194131458
Name:KRUSE, JAMIE S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:S
Last Name:KRUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:S
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:117 FLINN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2471
Mailing Address - Country:US
Mailing Address - Phone:224-803-2295
Mailing Address - Fax:
Practice Address - Street 1:117 FLINN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2471
Practice Address - Country:US
Practice Address - Phone:224-803-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490166621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical