Active NPI
Herbert Clinton-Cooper Krueger
- Social Worker
- Benton Harbor, MI
National Provider Identifier
1124535281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802089795
- Practice address
- 1613 M 139
Benton Harbor, MI 49022-5748 - Phone
- (269) 934-1694
- NPI assigned
- Jan 10, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802089795 | MI | Primary |
Addresses
Primary practice location
1613 M 139
Benton Harbor, MI 49022-5748
Mailing address
1485 M 139
Benton Harbor, MI 49022-5711
Phone (269) 925-0585
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802089795 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608595200000",
"number": "1124535281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1485 M 139",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490225711",
"telephone_number": "269-925-0585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1613 M 139",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490225748",
"telephone_number": "269-934-1694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUEGER",
"first_name": "HERBERT",
"middle_name": "CLINTON-COOPER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-10",
"last_updated": "2020-12-22",
"certification_date": "2020-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802089795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.