Provider Demographics
NPI:1295111870
Name:GRYGIEL, MARGARET MARY
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:GRYGIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:GRYGIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 MAIN ST STE 502
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6062
Mailing Address - Country:US
Mailing Address - Phone:541-331-0596
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN ST STE 502
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6062
Practice Address - Country:US
Practice Address - Phone:554-331-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-11-17101YA0400X
171M00000X
ORC5997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500696772Medicaid