Provider Demographics
NPI:1447698253
Name:KRUEGER, JODIE ANNE (BA)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ANNE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ANNE
Other - Last Name:WHITCHOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3 GARRETT LN
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2739
Mailing Address - Country:US
Mailing Address - Phone:508-523-1479
Mailing Address - Fax:
Practice Address - Street 1:3 GARRETT LN
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2739
Practice Address - Country:US
Practice Address - Phone:508-523-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst