Individual provider Active NPI

Roxanne Lynne Kruger, MA, LLPC

  • Counselor
  • Grand Rapids, MI
National Provider Identifier
1114588761
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
6401017416 Issued in MI
Practice address
800 Monroe Ave NW
Grand Rapids, MI 49503-1445
Phone
(517) 769-4444
NPI assigned
Jun 25, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 6401017416 MI Primary

Addresses

Primary practice location

800 Monroe Ave NW
Grand Rapids, MI 49503-1445

Mailing address

552 Fulton St E # 2
Grand Rapids, MI 49503-5923
Phone (517) 769-4444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6401017416MIMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Roxanne Kruger Counseling Services LLC Current Accepting new patients
Brave Grand Rapids LLC Past Accepting new patients

Locations

800 Monroe Ave NW
Ste 319
Grand Rapids, MI 49503
Phone (616) 275-4646

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1114588761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "552 FULTON ST E # 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035923",
            "telephone_number": "517-769-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MONROE AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031445",
            "telephone_number": "517-769-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUGER",
        "first_name": "ROXANNE",
        "middle_name": "LYNNE",
        "credential": "MA, LLPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401017416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.