Provider Demographics
NPI:1396231395
Name:KAYSER, VIRGINIA GRACE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:GRACE
Last Name:KAYSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINNA
Other - Middle Name:
Other - Last Name:KAYSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-0001
Mailing Address - Country:US
Mailing Address - Phone:541-942-3939
Mailing Address - Fax:541-942-3910
Practice Address - Street 1:288 MILL ST BLDG M
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4597
Practice Address - Country:US
Practice Address - Phone:541-942-3939
Practice Address - Fax:541-942-9310
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health