Provider Demographics
NPI:1306113873
Name:KRUEGER, SCOTT (RD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:W3275 WOLF RIVER ROAD
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135-0970
Mailing Address - Country:US
Mailing Address - Phone:715-799-5443
Mailing Address - Fax:715-799-3099
Practice Address - Street 1:W3275 WOLF RIVER ROAD
Practice Address - Street 2:
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135-0970
Practice Address - Country:US
Practice Address - Phone:715-799-5443
Practice Address - Fax:715-799-3099
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI820133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered