Healthcare Provider Details

I. General information

NPI: 1902725187
Provider Name (Legal Business Name): ANNABELLE STODD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

IV. Provider business mailing address

4914 SW DICKINSON ST
PORTLAND OR
97219-8650
US

V. Phone/Fax

Practice location:
  • Phone: 503-622-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: