Healthcare Provider Details

I. General information

NPI: 1245271246
Provider Name (Legal Business Name): DENISE E. STUNTZNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WOODLAND DR
COOS BAY OR
97420-2045
US

IV. Provider business mailing address

125 CENTRAL AVE STE 290
COOS BAY OR
97420-2342
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-5151
  • Fax:
Mailing address:
  • Phone: 541-267-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3811
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier93-0635514
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNORTH BEND MEDICAL CENTER GROUP TAX ID
# 2
Identifier161133
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNORTH BEND MEDICAL CENTER GROUP MEDICAID
# 3
IdentifierR0000WFBTV
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNORTH BEND MEDICAL CENTER GROUP MEDICARE
# 4
Identifier1407812365
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNORTH BEND MEDICAL CENTER GROUP NPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: