1205400405 NPI number — MRS. PAIGE KREUSER MS,LADC, LPCC

Table of content: MRS. PAIGE KREUSER MS,LADC, LPCC (NPI 1205400405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205400405 NPI number — MRS. PAIGE KREUSER MS,LADC, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREUSER
Provider First Name:
PAIGE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS,LADC, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205400405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
570 PROFESSIONAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55057-2756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-301-3412
Provider Business Mailing Address Fax Number:
507-301-3308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25590 ABERDEEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PRAGUE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56071-8815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-237-0415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  CC02839 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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