1740615848 NPI number — KRYSTAL KARIN ASHLING L.C.S.W.

Table of content: KRYSTAL KARIN ASHLING L.C.S.W. (NPI 1740615848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740615848 NPI number — KRYSTAL KARIN ASHLING L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHLING
Provider First Name:
KRYSTAL
Provider Middle Name:
KARIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740615848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14155 SW 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97005-3651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-547-9845
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14155 SW 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-547-9845
Provider Business Practice Location Address Fax Number:
503-296-5843
Provider Enumeration Date:
09/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  L1931SR , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: L1931 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L1931 . This is a "OREGON STATE BOARD OF CLINICAL SOCIAL WORKERS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: LW00005506 . This is a "INSURANCE PANELS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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