Provider Demographics
NPI:1265720924
Name:FOURCADE, KRISTEN COLLEEN MCCAFFREY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:COLLEEN MCCAFFREY
Last Name:FOURCADE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3255
Mailing Address - Country:US
Mailing Address - Phone:541-600-4451
Mailing Address - Fax:
Practice Address - Street 1:1407 E 18TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3255
Practice Address - Country:US
Practice Address - Phone:541-600-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No372600000XNursing Service Related ProvidersAdult Companion