Provider Demographics
NPI:1316704224
Name:KRUGER, AIDA ILEANA GARZA (LCSW)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:ILEANA GARZA
Last Name:KRUGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:LLEANA
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7002 TAOS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4326
Mailing Address - Country:US
Mailing Address - Phone:956-250-6433
Mailing Address - Fax:
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-225-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical