Healthcare Provider Details

I. General information

NPI: 1366974347
Provider Name (Legal Business Name): KGS LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 TAMARACK PL
ASHLAND OR
97520-3542
US

IV. Provider business mailing address

PO BOX 1426
TALENT OR
97540-1426
US

V. Phone/Fax

Practice location:
  • Phone: 541-821-2596
  • Fax: 541-488-7897
Mailing address:
  • Phone: 541-821-2596
  • Fax: 541-488-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA G SCHWEIKERT
Title or Position: SOLE MEMBER
Credential: LCSW
Phone: 541-821-2596