MEDICARE: SOPHIE STACH MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	R9557	OR

General Provider Information

NPI Number	:	1578391413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE STACH MA

Provider Business Mailing Address
First Line	:	6955 SW ROLLINGWOOD DR
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97008-5436
Country	:	US
Telephone Number	:	503-789-6561
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 MEADOWS RD STE 317
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4264
Country	:	US
Telephone Number	:	503-208-5713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	06/01/2026

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Directions to “ SOPHIE STACH MA” Practice Location

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