Provider Demographics
NPI:1952884876
Name:MEREDITH KRUGEL LCSW PC
Entity Type:Organization
Organization Name:MEREDITH KRUGEL LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:KRUGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-391-2883
Mailing Address - Street 1:850 PONDEROSA DR.
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-391-2883
Mailing Address - Fax:541-673-8060
Practice Address - Street 1:2225 NW STEWART PARKWAY STE 200
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-900-4285
Practice Address - Fax:888-810-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4071261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR173605Medicaid