Cory R Krueger, MS, LPC-IT, SAC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3039-226 Issued in WI

Practice address

1541 Annex Rd
Jefferson, WI 53549-9803

Phone

(920) 674-3105

NPI assigned

Oct 5, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1417407297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W7210 COUNTY ROAD V",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519645",
            "telephone_number": "920-648-5613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499803",
            "telephone_number": "920-674-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUEGER",
        "first_name": "CORY",
        "middle_name": "R",
        "credential": "MS, LPC-IT, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "17863-130",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3039-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Marie Knurek, LCSW
• Cheryl A Kolkovich, PA-C
• Hildegard Kopp
• Alicia Kraucunas
• Abigail Jane Krueger, MS, CCC-SLP
• Kari Lynn Kuffer, MS
• Melanie Agnes Kutz, R.N.
• Brooke T Kysely, MS, LPC, NCC
• Betsy Lane, LPC, CSAC
• Shayna Kelly Lang, MSW

• Professional Counselor in Jefferson, WI
• Providers in Jefferson, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.