Healthcare Provider Details

I. General information

NPI: 1053884791
Provider Name (Legal Business Name): LEEANDRIA N. WITCRAFT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 NEW WAY
KLAMATH FALLS OR
97601-9382
US

IV. Provider business mailing address

6000 NEW WAY
KLAMATH FALLS OR
97601-9382
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-240-8410
Mailing address:
  • Phone: 541-966-9830
  • Fax: 541-240-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10443
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: