Healthcare Provider Details

I. General information

NPI: 1306202825
Provider Name (Legal Business Name): STEPHANIE ROCHELLE TOLENTINO CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 12TH AVE
EUGENE OR
97401-3408
US

IV. Provider business mailing address

972 W 4TH AVE
EUGENE OR
97402-4931
US

V. Phone/Fax

Practice location:
  • Phone: 541-762-4300
  • Fax:
Mailing address:
  • Phone: 469-583-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA4186
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: