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General NPI Number Information
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NPI Number | 1992527337
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Entity Type | Individual
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Provider Name | MYKAH DEAN KRUMWIEDE CADC-R
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 435 E NEWPORT AVE
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City | HERMISTON
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State | OR
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Zip | 97838-2487
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Country | US
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Telephone | 541-564-9390
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Fax | 541-564-9384
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Provider Business Mailing Address
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Address Line | PO BOX 469
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City | HEPPNER
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State | OR
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Zip | 97836-0469
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Country | US
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Telephone | 541-676-9161
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Fax | 541-676-5662
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-25-3134
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License Number State | OR
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