Provider Demographics
NPI:1316116189
Name:SCHMIDLKOFER, KRISTIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:SCHMIDLKOFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 SW KECK DR # 211
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6691
Mailing Address - Country:US
Mailing Address - Phone:503-318-9692
Mailing Address - Fax:503-434-6290
Practice Address - Street 1:125 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4901
Practice Address - Country:US
Practice Address - Phone:503-210-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid