Healthcare Provider Details

I. General information

NPI: 1003347386
Provider Name (Legal Business Name): STEPHANIE LYNN EVANS-WONDRA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY STE 120
EUGENE OR
97408-7619
US

IV. Provider business mailing address

1220 34TH PL
FLORENCE OR
97439-8936
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-2800
  • Fax:
Mailing address:
  • Phone: 541-999-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5336
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: