Active NPI
Jacquelyn C Kruse, M.S. L.C.P.C.
- Mental Health Counselor
- Elgin, IL
National Provider Identifier
1760607246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1814 Grandstand Place
Elgin, IL 60123-4981 - Phone
- (847) 622-0002
- Fax
- (847) 622-0002
- NPI assigned
- Apr 17, 2007
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IL | Primary |
Addresses
Primary practice location
1814 Grandstand Place
Elgin, IL 60123-4981
Mailing address
19N109 Sleepy Hollow Rd
Dundee, IL 60118-9235
Phone (847) 426-8376
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 |
|---|---|---|---|
| 180-001428 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760607246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19N109 SLEEPY HOLLOW RD",
"city": "DUNDEE",
"state": "IL",
"postal_code": "601189235",
"telephone_number": "847-426-8376",
"fax_number": "847-426-8376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 GRANDSTAND PLACE",
"city": "ELGIN",
"state": "IL",
"postal_code": "601234981",
"telephone_number": "847-622-0002",
"fax_number": "847-622-0002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUSE",
"first_name": "JACQUELYN",
"middle_name": "C",
"name_prefix": "Ms.",
"credential": "M.S. L.C.P.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elgin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.