Kristin Simons Holmberg, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L6124 Issued in OR

Practice address

2542 Courtney Drive
St. Charles Behavioral Health
Bend, OR 97701

Phone

(541) 706-2768

Fax

(541) 706-4760

NPI assigned

May 22, 2008

Last updated

Jun 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Kristin Lynn Simons Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kristi Holmberg

  dba Groundwork, LLC

  • Clinical Social Worker
  • Bend, OR
  • NPI 1003451253
  NPD Authorized official

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1992962252",
    "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",
            "fax_number": "541-318-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2542 COURTNEY DRIVE",
            "address_2": "ST. CHARLES BEHAVIORAL HEALTH",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-706-2768",
            "fax_number": "541-706-4760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "497 SW Century Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977021167",
            "country_code": "US",
            "telephone_number": "458-292-9972",
            "fax_number": "541-318-0058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLMBERG",
        "first_name": "KRISTIN",
        "middle_name": "SIMONS",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-22",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW 00009581",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "SIMONS",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "MSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Angela Holloway, MA
• Dorothy Jean Holloway, LPC, RN
• Sandra K Holloway, MD
• Sarah Holloway, RN
• Dennis Jon Holly, DMD
• Tim J Holmberg, MD
• Jeffrey Arthur Holmboe, M.D.
• Katharine Holmer, PT
• Heidi Lind Holmes, PA-C
• Sophia Holms

• 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, 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.