Healthcare Provider Details

I. General information

NPI: 1093960627
Provider Name (Legal Business Name): STEPHANIE CHRISTINE EVANS PSYD, BA, RC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 SE 1ST ST
PENDLETON OR
97801-2203
US

IV. Provider business mailing address

135 SE 1ST ST
PENDLETON OR
97801-2203
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-2222
  • Fax: 541-276-8405
Mailing address:
  • Phone: 541-278-2222
  • Fax: 541-276-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2769
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: