Individual
STEPHANIE MARIE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
726 W BURNSIDE ST, PORTLAND, OR 97209-3515
(503) 944-4410
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW3862
OR
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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