MEDICARE: DR. STEPHANIE LENAY FITZPATRICK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2774	OR

General Provider Information

NPI Number	:	1033406319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LENAY FITZPATRICK PH.D.

Provider Business Mailing Address
First Line	:	6228 NE GRAND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3049
Country	:	US
Telephone Number	:	502-345-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	6228 NE GRAND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3049
Country	:	US
Telephone Number	:	502-345-1476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	11/19/2025

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