Healthcare Provider Details

I. General information

NPI: 1720184880
Provider Name (Legal Business Name): LINDA S. STEAD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 SUPERIOR CT STE 103
MEDFORD OR
97504-6179
US

IV. Provider business mailing address

670 SUPERIOR CT STE 103
MEDFORD OR
97504-6179
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-5993
  • Fax: 541-646-7969
Mailing address:
  • Phone: 541-772-5993
  • Fax: 541-646-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2053
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: