Healthcare Provider Details

I. General information

NPI: 1861645137
Provider Name (Legal Business Name): KRISTIN KAHLE WROBLESKI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 NW MT WASHINGTON DR STE 303
BEND OR
97703-1576
US

IV. Provider business mailing address

745 NW MT WASHINGTON DR STE 303
BEND OR
97703-1576
US

V. Phone/Fax

Practice location:
  • Phone: 541-696-3839
  • Fax:
Mailing address:
  • Phone: 541-696-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: