MEDICARE: MEREDITH C KRUGEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L4071	OR

General Provider Information

NPI Number	:	1720271976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH C KRUGEL LCSW

Provider Business Mailing Address
First Line	:	850 PONDEROSA DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-8923
Country	:	US
Telephone Number	:	541-391-2883
Fax Number	:	541-673-2270

Provider Business Practice Location Address
First Line	:	272 NW MEDICAL LOOP STE E
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5545
Country	:	US
Telephone Number	:	541-900-4285
Fax Number	:	888-810-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	01/23/2020

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