Provider Demographics
NPI:1093373631
Name:STASKO, EMILY CATHERINE (MPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:CATHERINE
Last Name:STASKO
Suffix:
Gender:F
Credentials:MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 NW RALEIGH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1775
Mailing Address - Country:US
Mailing Address - Phone:215-827-9878
Mailing Address - Fax:
Practice Address - Street 1:1950 NW RALEIGH ST APT 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1775
Practice Address - Country:US
Practice Address - Phone:215-827-9878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTBD103TH0004X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service