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Individual

AUTUMN SAGE STOUTENBURGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSW, CSWA

Contact information

Practice address
678 PARK ST, ASHLAND, OR 97520-2504
(541) 521-6537
Mailing address
678 PARK ST, ASHLAND, OR 97520-2504
(541) 521-6537

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A4715
OR
1041C0700X
Clinical Social Worker
A4715
OR

Other

Enumeration date
05/20/2020
Last updated
05/21/2020
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