Basic Information
| Provider Information | |||||||||
| NPI: | 1962016766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUEGER | ||||||||
| FirstName: | CIARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.ED., LPC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5118 LACY RD UNIT 301 | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537115750 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2987 YARMOUTH GREENWAY DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537115852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086308889 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2020 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4221-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.