Active NPI
Stacy Krug, CDAC
- Addiction (Substance Use Disorder) Counselor
- Marion, IA
National Provider Identifier
1699328773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 19040
- Practice address
- 151 Marion Blvd
Marion, IA 52302-3135 - Phone
- (319) 363-2878
- Fax
- (319) 364-2159
- NPI assigned
- Jul 18, 2019
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 19040 | IA | Primary |
Addresses
Primary practice location
151 Marion Blvd
Marion, IA 52302-3135
Mailing address
1190 Maplecrest Dr
Marion, IA 52302-2141
Phone (319) 651-8118
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 |
|---|---|---|---|
| 19040 | IA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563408000000",
"number": "1699328773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1190 MAPLECREST DR",
"city": "MARION",
"state": "IA",
"postal_code": "523022141",
"telephone_number": "319-651-8118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 MARION BLVD",
"city": "MARION",
"state": "IA",
"postal_code": "523023135",
"telephone_number": "319-363-2878",
"fax_number": "319-364-2159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUG",
"first_name": "STACY",
"credential": "CDAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-18",
"last_updated": "2019-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IA",
"license": "19040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.