| NPI | 1376735084 |
|---|---|
| Former Name | MANDY LYNN KRUECKEBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006139A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN N/A) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2025-05-13 |