Provider Demographics
NPI:1295020824
Name:KRIEGER, VIVIAN MICHELE
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MICHELE
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9475
Mailing Address - Country:US
Mailing Address - Phone:503-725-3806
Mailing Address - Fax:
Practice Address - Street 1:360 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9475
Practice Address - Country:US
Practice Address - Phone:503-725-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health