Provider Demographics
NPI:1407081623
Name:KRUEGER, LYNDA
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2920
Mailing Address - Country:US
Mailing Address - Phone:618-466-2134
Mailing Address - Fax:618-466-0392
Practice Address - Street 1:812 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2920
Practice Address - Country:US
Practice Address - Phone:618-466-2134
Practice Address - Fax:618-466-0392
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist