Individual
STACY MEDOF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
THW, PSS, PWS
Contact information
Practice address
4200 SW 107TH AVE APT 2105, BEAVERTON, OR 97005-3154
(818) 826-3277
Mailing address
4200 SW 107TH AVE APT 2105, BEAVERTON, OR 97005-3154
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
107826
OR
Other
Enumeration date
07/31/2025
Last updated
07/31/2025
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