Provider Demographics
NPI:1194487785
Name:STEFANOVICH, VONA (LMT)
Entity Type:Individual
Prefix:
First Name:VONA
Middle Name:
Last Name:STEFANOVICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:VONA
Other - Middle Name:
Other - Last Name:ENRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:229 NW FAIRHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1190
Mailing Address - Country:US
Mailing Address - Phone:907-254-4886
Mailing Address - Fax:
Practice Address - Street 1:880 LIBERTY ST NE RM 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2450
Practice Address - Country:US
Practice Address - Phone:907-254-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist