Provider Demographics
NPI:1487024345
Name:PANKRATZ, KRISTIN LENORE (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LENORE
Last Name:PANKRATZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LENORE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2645 PORTLAND RD NE STE 120
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0200
Mailing Address - Country:US
Mailing Address - Phone:503-390-5637
Mailing Address - Fax:
Practice Address - Street 1:2645 PORTLAND RD NE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0200
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-03
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor