Provider Demographics
NPI:1083015119
Name:FLEMING, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BUGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CLC
Mailing Address - Street 1:4885 ASTER ST APT 86
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6899
Mailing Address - Country:US
Mailing Address - Phone:303-884-5381
Mailing Address - Fax:
Practice Address - Street 1:4885 ASTER ST APT 86
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6899
Practice Address - Country:US
Practice Address - Phone:303-884-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTALPP-34455174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN