Kristi Holmberg

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KRISTI HOLMBERG

Practice address

497 SW Century Dr Ste 102
Bend, OR 97702-1167

Phone

(458) 292-9972

Fax

(541) 318-0058

NPI assigned

Nov 12, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristin Simons Holmberg, LCSWNPI 1992962252

Title

Owner

Phone

(458) 292-9972

Specialties & licenses 2

Addresses

Other names 1

• Groundwork, LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin Simons Holmberg, LCSW

  • Clinical Social Worker
  • Bend, OR
  • NPI 1992962252
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1003451253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR STE 102",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "458-292-9972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR STE 102",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "458-292-9972",
            "fax_number": "541-318-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTI HOLMBERG",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "HOLMBERG",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "SIMONS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "458-292-9972",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Groundwork, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert B Kravitz, CACD-I
• Michell L Kreft, OT
• Jamie Lynn Krefting, PT, DPT
• Jason M. Kremer, D.C., CSCS
• David Krieves, MD
• Kristi Jett, MD
• Tessa Kristiansen, CRM
• Kristin Brooks Pmhnp LLC
• Kristin Mathes Clinical Mental Health
• Stephen Daniel Krivan, PA-C

• Clinical Social Worker in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.