Healthcare Provider Details

I. General information

NPI: 1336722651
Provider Name (Legal Business Name): SILVIA TSAI LUU STANTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 S RIVERSIDE AVE
MEDFORD OR
97501-7837
US

IV. Provider business mailing address

713 S RIVERSIDE AVE
MEDFORD OR
97501-7837
US

V. Phone/Fax

Practice location:
  • Phone: 541-203-0055
  • Fax: 541-227-2356
Mailing address:
  • Phone: 541-203-0055
  • Fax: 541-227-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18058
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: