Healthcare Provider Details

I. General information

NPI: 1538081062
Provider Name (Legal Business Name): STONE & STEM PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 SW 25TH ST
REDMOND OR
97756-9089
US

IV. Provider business mailing address

2152 SW 25TH ST
REDMOND OR
97756-9089
US

V. Phone/Fax

Practice location:
  • Phone: 541-208-5373
  • Fax:
Mailing address:
  • Phone: 541-208-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: POLLY REISIG
Title or Position: OWNER
Credential: LCSW
Phone: 541-208-5373