Active NPI
Jessica Kruckeberg, LMFT
- Marriage & Family Therapist
- Aurora, CO
National Provider Identifier
1629513130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 0001336
- Practice address
- 2101 S Blackhawk St
Suite 240
Aurora, CO 80014-1492 - Phone
- (612) 360-9935
- NPI assigned
- Dec 20, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 0001336 | CO | Primary |
Addresses
Primary practice location
2101 S Blackhawk St
Suite 240
Aurora, CO 80014-1492
Mailing address
12835 E Arapahoe Road
Tower 2, Suite 440
Centennial, CO 80112-3940
Phone (720) 288-0645
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 |
|---|---|---|---|
| 0001336 | CO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1629513130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12835 E ARAPAHOE ROAD",
"address_2": "TOWER 2, SUITE 440",
"city": "CENTENNIAL",
"state": "CO",
"postal_code": "801123940",
"telephone_number": "720-288-0645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 S BLACKHAWK ST",
"address_2": "SUITE 240",
"city": "AURORA",
"state": "CO",
"postal_code": "800141492",
"telephone_number": "612-360-9935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUCKEBERG",
"first_name": "JESSICA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-20",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CO",
"license": "0001336",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.