Provider Demographics
NPI:1699287177
Name:KROEGER, JILL ELIZABETH
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:KROEGER
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 1:314 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2448
Mailing Address - Country:US
Mailing Address - Phone:952-257-8800
Mailing Address - Fax:
Practice Address - Street 1:314 MAIN ST E
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2448
Practice Address - Country:US
Practice Address - Phone:952-257-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist