Healthcare Provider Details

I. General information

NPI: 1164820478
Provider Name (Legal Business Name): NEUROPSYCHOLOGICAL SERVICES OF OREGON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MELTON RD
CRESWELL OR
97426-9453
US

IV. Provider business mailing address

PO BOX 249
CRESWELL OR
97426-0249
US

V. Phone/Fax

Practice location:
  • Phone: 541-306-6456
  • Fax: 541-647-1580
Mailing address:
  • Phone: 541-306-6456
  • Fax: 541-647-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2524
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2524
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TRACY N KREILING
Title or Position: OWNER
Credential: PSYD
Phone: 541-306-6456