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General NPI Number Information
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NPI Number | 1114889979
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Entity Type | Individual
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Provider Name | JORDIN ANTON STEPAN
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Gender | Male
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 3710 PORTLAND RD NE STE 100
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City | SALEM
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State | OR
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Zip | 97301-0312
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Country | US
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Telephone | 971-703-4623
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Fax | 971-266-5668
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Provider Business Mailing Address
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Address Line | 1129 COBURG RD APT 1
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City | EUGENE
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State | OR
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Zip | 97401-5185
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Country | US
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Telephone | 971-703-4623
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Fax | 971-266-5668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 24-05-11119
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License Number State | OR
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