Individual
STEPHANIE BUECKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC R
Contact information
Practice address
1059 NW MADRAS HWY, PRINEVILLE, OR 97754-1416
(541) 323-5330
Mailing address
PO BOX 1710, REDMOND, OR 97756-0516
(541) 516-4097
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
T-22-1454
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHACBO
T-22-1454
OR
Enumeration date
04/14/2022
Last updated
04/14/2022
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