Healthcare Provider Details

I. General information

NPI: 1134782352
Provider Name (Legal Business Name): HANNA JO STONELAKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 COLLINS WAY STE 202
LAKE OSWEGO OR
97035-3459
US

IV. Provider business mailing address

3312 SW 11TH AVE
PORTLAND OR
97239-2915
US

V. Phone/Fax

Practice location:
  • Phone: 503-675-2830
  • Fax:
Mailing address:
  • Phone: 541-513-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL8034
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: