Provider Demographics
NPI:1083349906
Name:STAFFORD, KADY (REGISTERED ASSOCIATE)
Entity Type:Individual
Prefix:MS
First Name:KADY
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:REGISTERED ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13574 SW HIGHWAY 126
Mailing Address - Street 2:
Mailing Address - City:POWELL BUTTE
Mailing Address - State:OR
Mailing Address - Zip Code:97753-1541
Mailing Address - Country:US
Mailing Address - Phone:541-480-6360
Mailing Address - Fax:
Practice Address - Street 1:7515 FALCON CREST DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5014
Practice Address - Country:US
Practice Address - Phone:541-904-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor