Provider Demographics
NPI:1134429442
Name:SHRADER, KRISTEN (CSWA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:CSWA
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 7497
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0151
Mailing Address - Country:US
Mailing Address - Phone:503-585-0351
Mailing Address - Fax:
Practice Address - Street 1:1675 WINTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7152
Practice Address - Country:US
Practice Address - Phone:503-585-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA133091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical