Provider Demographics
NPI:1124288550
Name:KRUEBBE, CHRISTOPHER KARL (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KARL
Last Name:KRUEBBE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3575
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97107-3575
Mailing Address - Country:US
Mailing Address - Phone:541-450-7991
Mailing Address - Fax:
Practice Address - Street 1:9465 THIRD STREET
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:OR
Practice Address - Zip Code:97107
Practice Address - Country:US
Practice Address - Phone:541-450-7991
Practice Address - Fax:541-472-0009
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235811041C0700X
ORL57711041C0700X
LA116641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR171558OtherMEDICARE PART B PTAN