Provider Demographics
NPI:1154605228
Name:SCHWEIKERT, KRISTINA G (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:G
Last Name:SCHWEIKERT
Suffix:
Gender:F
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 1426
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-1426
Mailing Address - Country:US
Mailing Address - Phone:541-821-2596
Mailing Address - Fax:541-488-7897
Practice Address - Street 1:1983 TAMARACK PL
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3542
Practice Address - Country:US
Practice Address - Phone:541-821-2596
Practice Address - Fax:541-488-7897
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6541101Y00000X, 101Y00000X
ORL64511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689907Medicaid