1215150206 NPI number — MRS. STEPHANIE ROCHELLE LENZ LMT

Table of content: MRS. STEPHANIE ROCHELLE LENZ LMT (NPI 1215150206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215150206 NPI number — MRS. STEPHANIE ROCHELLE LENZ LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENZ
Provider First Name:
STEPHANIE
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGILLIS
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ROCHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215150206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 NE 146TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-8006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-995-5254
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3716 SE INTERNATIONAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-0073
Provider Business Practice Location Address Fax Number:
503-659-7471
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  13117 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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