Healthcare Provider Details

I. General information

NPI: 1194661892
Provider Name (Legal Business Name): THEO STEWART-FRANZEN, PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 TALENT AVE
TALENT OR
97540-9627
US

IV. Provider business mailing address

1710 TALENT AVE
TALENT OR
97540-9627
US

V. Phone/Fax

Practice location:
  • Phone: 612-322-3497
  • Fax:
Mailing address:
  • Phone: 612-322-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE ZIGELNIK STEWART-FRANZEN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 612-322-3497