Healthcare Provider Details

I. General information

NPI: 1225747900
Provider Name (Legal Business Name): STEFANIE VIGIL-HAWK PWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5562 WINTERFIELD WAY
KLAMATH FALLS OR
97603-8235
US

IV. Provider business mailing address

5562 WINTERFIELD WAY
KLAMATH FALLS OR
97603-8235
US

V. Phone/Fax

Practice location:
  • Phone: 541-281-9893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: