Provider Demographics
NPI:1376014027
Name:STEPHENSON, MARIAHM (CHES)
Entity Type:Individual
Prefix:MS
First Name:MARIAHM
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 SW MILLIKAN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1687
Mailing Address - Country:US
Mailing Address - Phone:503-906-7928
Mailing Address - Fax:844-301-4226
Practice Address - Street 1:12725 SW MILLIKAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1687
Practice Address - Country:US
Practice Address - Phone:503-906-7928
Practice Address - Fax:844-301-4226
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25781174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator