Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003974437 |
---|---|
Provider Name | Stephanie D Guerena |
First Address | Corvallis, OR 97339-0579 |
Second Address | Corvallis, OR 97330-5223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 10/11/2008 |