Healthcare Provider Details

I. General information

NPI: 1215844568
Provider Name (Legal Business Name): LISA MICHELLE KRIGBAUM MS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 LANCASTER DR NE
SALEM OR
97305-1130
US

IV. Provider business mailing address

1255 RESERVE ST UNIT 120
SILVERTON OR
97381-2046
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-3000
  • Fax:
Mailing address:
  • Phone: 509-499-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18926
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: