Active NPI
Lonnie M Kruger, MSW, SAC-IT
- Mental Health Counselor
- Green Bay, WI
National Provider Identifier
1356626519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 15385-130
- Practice address
- 300 Crooks St
Green Bay, WI 54301-4527 - Phone
- (920) 436-6800
- Fax
- (920) 437-3540
- NPI assigned
- Oct 19, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 15385-130 | WI | Primary |
Addresses
Primary practice location
300 Crooks St
Green Bay, WI 54301-4527
Mailing address
300 Crooks St
Green Bay, WI 54301-4527
Phone (920) 436-6800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15835-130 | Other | WI | SAC-IT |
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 |
|---|---|---|---|
| 15385-130 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318982400000",
"number": "1356626519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 CROOKS ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543014527",
"telephone_number": "920-436-6800",
"fax_number": "920-437-3540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 CROOKS ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543014527",
"telephone_number": "920-436-6800",
"fax_number": "920-437-3540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUGER",
"first_name": "LONNIE",
"middle_name": "M",
"credential": "MSW, SAC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-19",
"last_updated": "2011-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "15385-130",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SAC-IT",
"identifier": "15835-130",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.