Kristin Carol Diasio, MS SPECIAL EDUCATION

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

25 Erickson Ave
Shady Cove, OR 97539-9758

Phone

(541) 816-4415

NPI assigned

Apr 17, 2019

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Kristin Carol Chargualaf Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1265095954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 MEDFORD CTR # 264",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046772",
            "telephone_number": "541-816-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 ERICKSON AVE",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "975399758",
            "telephone_number": "541-816-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIASIO",
        "first_name": "KRISTIN",
        "middle_name": "CAROL",
        "name_prefix": "Ms.",
        "credential": "MS SPECIAL EDUCATION",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386091569",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kris@redemptionridge.com",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "711 Medford Ctr # 264",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975046772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "CHARGUALAF",
            "middle_name": "CAROL",
            "prefix": "MRS.",
            "credential": "BA SOCIOLOGY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Social Worker in Shady Cove, OR
• Providers in Shady Cove, OR by specialty
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; 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.