Provider Demographics
NPI:1316241813
Name:KROEGER, ERINN (LADC, LSW)
Entity type:Individual
Prefix:
First Name:ERINN
Middle Name:
Last Name:KROEGER
Suffix:
Gender:F
Credentials:LADC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3897 WILLOWWOOD ST SW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4301
Mailing Address - Country:US
Mailing Address - Phone:218-590-0932
Mailing Address - Fax:
Practice Address - Street 1:4769 DAKOTA ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1797
Practice Address - Country:US
Practice Address - Phone:952-447-4344
Practice Address - Fax:952-447-4346
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302795101YA0400X
MN18320104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker