Provider Demographics
NPI:1427054543
Name:KRUEGER, ERIN LEE (AUD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LEE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:LEE
Other - Last Name:PETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:130 2ND ST
Mailing Address - Street 2:SUITE 198
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2883
Mailing Address - Country:US
Mailing Address - Phone:920-729-2085
Mailing Address - Fax:920-303-4148
Practice Address - Street 1:855 N WESTHAVEN DR
Practice Address - Street 2:STE 200
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7668
Practice Address - Country:US
Practice Address - Phone:920-303-4130
Practice Address - Fax:920-303-4148
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI408156231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41147000Medicaid
WIP95686Medicare UPIN
WI41147000Medicaid