Individual
STACEY BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
331 SE 2ND ST, PENDLETON, OR 97801-2224
(541) 276-4628
Mailing address
702 SUNSET DR, ONTARIO, OR 97914-3121
(541) 889-9167
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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