Healthcare Provider Details

I. General information

NPI: 1578669339
Provider Name (Legal Business Name): STEPHANIE WILLIAMS MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 NE GREENWOOD AVE STE 202
BEND OR
97701-4632
US

IV. Provider business mailing address

1531 NW 10TH ST UNIT A
BEND OR
97703-1693
US

V. Phone/Fax

Practice location:
  • Phone: 503-899-3793
  • Fax: 949-703-8217
Mailing address:
  • Phone: 503-899-3793
  • Fax: 949-703-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4240
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: