Provider Demographics
NPI:1366774689
Name:DORO-KRUEGER, TRACY LYNN (LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:DORO-KRUEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 ARAPAHO COURT
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024
Mailing Address - Country:US
Mailing Address - Phone:414-324-0718
Mailing Address - Fax:
Practice Address - Street 1:1814 ARAPAHO COURT
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024
Practice Address - Country:US
Practice Address - Phone:414-324-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4340-125OtherWI LICENSE