Active NPI
John R Krueger, LP, LICSW
- Psychologist
- Saint Cloud, MN
National Provider Identifier
1861673030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP0553
- Practice address
- 157 Roosevelt Rd Ste 300
Saint Cloud, MN 56301-5481 - Phone
- (320) 240-3324
- Fax
- (320) 240-3339
- NPI assigned
- Nov 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP0553 | MN | Primary |
| Clinical Social Worker | 1041C0700X | 3705 | MN |
Addresses
Primary practice location
157 Roosevelt Rd Ste 300
Saint Cloud, MN 56301-5481
Mailing address
PO Box 2390
Saint Cloud, MN 56302-2390
Phone (320) 650-1544
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 |
|---|---|---|---|
| LP0553 | MN | MD | Psychologist |
| 3705 | MN | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities of the Diocese of St. Cloud | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adult Mental Health Clinic/Center
- Saint Cloud, MN
- NPI 1003944620
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195171200000",
"number": "1861673030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2390",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563022390",
"telephone_number": "320-650-1544",
"fax_number": "320-650-1528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "157 ROOSEVELT RD STE 300",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563015481",
"telephone_number": "320-240-3324",
"fax_number": "320-240-3339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUEGER",
"first_name": "JOHN",
"middle_name": "R",
"credential": "LP, LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-16",
"last_updated": "2007-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP0553",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "3705",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.