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General NPI Number Information
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NPI Number | 1326159773
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Entity Type | Organization
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Legal Business Name | MARY ANNE STOWELL LCSW, PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/11/2010
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Provider Practice Location Address
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Address Line | 4511 SE HAWTHORNE BLVD SUITE 114
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City | PORTLAND
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State | OR
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Zip | 97215-3170
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Country | US
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Telephone | 503-232-6868
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Fax | 503-253-1285
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Provider Business Mailing Address
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Address Line | 4511 SE HAWTHORNE BLVD SUITE 114
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City | PORTLAND
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State | OR
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Zip | 97215-3170
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Country | US
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Telephone | 503-232-6868
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Fax | 503-253-1285
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Authorized Official
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Title or Position | CEO
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Name | MARY ANNE STOWELL
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Credential | LCSW
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Telephone | 503-408-1759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L2934
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License Number State | OR
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