Provider Demographics
NPI:1295758738
Name:KRUEGER, DAWN MARIE (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 S 76TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4360
Mailing Address - Country:US
Mailing Address - Phone:414-282-8353
Mailing Address - Fax:414-282-8353
Practice Address - Street 1:4810 S 76TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4360
Practice Address - Country:US
Practice Address - Phone:414-282-8353
Practice Address - Fax:414-282-8353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2727-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11441516OtherCAQH #