Healthcare Provider Details

I. General information

NPI: 1821185422
Provider Name (Legal Business Name): LAURA N STOCKFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA J STOCKFORD

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 PEARL ST
EUGENE OR
97401-3573
US

IV. Provider business mailing address

PO BOX 2632
EUGENE OR
97402-0237
US

V. Phone/Fax

Practice location:
  • Phone: 541-729-8385
  • Fax:
Mailing address:
  • Phone: 541-729-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2930
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500613596
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: