Basic Information
| Provider Information | |||||||||
| NPI: | 1720271976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUGEL | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 PONDEROSA DR | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974718923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413912883 | ||||||||
| FaxNumber: | 5416732270 | ||||||||
| Practice Location | |||||||||
| Address1: | 272 NW MEDICAL LOOP STE E | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974715545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419004285 | ||||||||
| FaxNumber: | 8888102993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L4071 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.