Healthcare Provider Details

I. General information

NPI: 1407041775
Provider Name (Legal Business Name): MARILYN STEPHENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 SW SPARROW LOOP UNIT 102
BEAVERTON OR
97007-9358
US

IV. Provider business mailing address

15200 SW SPARROW LOOP UNIT 102
BEAVERTON OR
97007-9358
US

V. Phone/Fax

Practice location:
  • Phone: 808-463-4287
  • Fax: 503-961-1779
Mailing address:
  • Phone: 808-463-4287
  • Fax: 503-961-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7646
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: