Basic Information
| Provider Information | |||||||||
| NPI: | 1952884876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEREDITH KRUGEL LCSW PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 PONDEROSA DR. | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413912883 | ||||||||
| FaxNumber: | 5416738060 | ||||||||
| Practice Location | |||||||||
| Address1: | 2225 NW STEWART PARKWAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419004285 | ||||||||
| FaxNumber: | 8888102993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2018 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | KRUGEL | ||||||||
| AuthorizedOfficialFirstName: | MEREDITH | ||||||||
| AuthorizedOfficialMiddleName: | COLLINS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5413912883 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | L4071 | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | R173605 | 05 | OR | MEDICAID |