Provider Demographics
NPI:1265213789
Name:KRIEGEL, HANSON ELLIS DAVENPORT (CSWA, MSW)
Entity type:Individual
Prefix:
First Name:HANSON
Middle Name:ELLIS DAVENPORT
Last Name:KRIEGEL
Suffix:
Gender:F
Credentials:CSWA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 NW DIVISION ST STE 165
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5295
Mailing Address - Country:US
Mailing Address - Phone:971-220-2496
Mailing Address - Fax:
Practice Address - Street 1:2951 NW DIVISION ST STE 165
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5295
Practice Address - Country:US
Practice Address - Phone:971-220-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA14435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker