Provider Demographics
NPI:1558187245
Name:KRUEGER, JESSICA (LPC, NCC, MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LPC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LOOMIS DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2419
Mailing Address - Country:US
Mailing Address - Phone:419-740-0148
Mailing Address - Fax:
Practice Address - Street 1:122 W FRONT ST STE D
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1467
Practice Address - Country:US
Practice Address - Phone:419-377-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional