Provider Demographics
NPI:1417381864
Name:KRAMER, CHRISTA E (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:E
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4729
Mailing Address - Country:US
Mailing Address - Phone:503-585-6388
Mailing Address - Fax:503-585-6388
Practice Address - Street 1:435 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4729
Practice Address - Country:US
Practice Address - Phone:503-585-6388
Practice Address - Fax:503-585-6388
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC4612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500733397Medicaid
MA1303414Medicaid