Healthcare Provider Details

I. General information

NPI: 1932758224
Provider Name (Legal Business Name): DR. STACIE ROWAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 301
EUGENE OR
97401-3154
US

IV. Provider business mailing address

132 E BROADWAY STE 301
EUGENE OR
97401-3154
US

V. Phone/Fax

Practice location:
  • Phone: 541-337-5301
  • Fax: 844-671-7143
Mailing address:
  • Phone: 541-337-5301
  • Fax: 844-671-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: STACIE LEE FISHELL ROWAN
Title or Position: AO/PSYCHOLOGIST
Credential: PHD
Phone: 541-337-5301