Healthcare Provider Details

I. General information

NPI: 1942866470
Provider Name (Legal Business Name): STEPHEN HANS STOLTZFUS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 25TH ST SE STE 420
SALEM OR
97302-1285
US

IV. Provider business mailing address

607 E 3RD ST
NEWBERG OR
97132-3105
US

V. Phone/Fax

Practice location:
  • Phone: 503-364-6093
  • Fax: 503-364-5121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3646
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: