Individual
STACY L MANDZIJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1310 SW 17TH AVE, PORTLAND, OR 97201-2522
(503) 231-2641
(503) 467-4077
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L8570
OR
1041C0700X
Clinical Social Worker
Primary
L8570
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500734958
—
OR
Enumeration date
09/19/2017
Last updated
03/13/2026
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