Organization
MARY ANNE STOWELL LCSW, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANNE STOWELL LCSW (CEO)
(503) 408-1759
Entity
Organization
Contact information
Practice address
4511 SE HAWTHORNE BLVD, SUITE 114, PORTLAND, OR 97215-3170
(503) 232-6868
(503) 253-1285
Mailing address
4511 SE HAWTHORNE BLVD, SUITE 114, PORTLAND, OR 97215-3170
(503) 232-6868
(503) 253-1285
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2934
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001095800
MHN
—
05
—
182996
—
OR
01
—
330833000001
PROVIDENCE HEALTH PLAN
—
01
—
475273
HTH WORLD WIDE
—
01
—
7299505
AETNA
—
01
—
825404000
REGENCE BLUE CROSS
OR
Enumeration date
08/31/2006
Last updated
10/11/2010
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