Provider Demographics
NPI:1366974347
Name:KGS LCSW
Entity type:Organization
Organization Name:KGS LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHWEIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-821-2596
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORL6451305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689907Medicaid
ORR185983Medicare PIN