Provider Demographics
NPI:1417045469
Name:KRYZANEK, ROGER ALLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ALLEN
Last Name:KRYZANEK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7334
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-7334
Mailing Address - Country:US
Mailing Address - Phone:541-382-8870
Mailing Address - Fax:541-382-8870
Practice Address - Street 1:336 NE NORTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4350
Practice Address - Country:US
Practice Address - Phone:541-382-8870
Practice Address - Fax:541-382-8870
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL01541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical