Provider Demographics
NPI:1376934885
Name:STYBANIEWICZ, AGNIESZKA
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:STYBANIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 W 29TH PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2506
Mailing Address - Country:US
Mailing Address - Phone:541-790-9081
Mailing Address - Fax:
Practice Address - Street 1:770 E 11TH AVE
Practice Address - Street 2:SSB- 1ST FLOOR
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3746
Practice Address - Country:US
Practice Address - Phone:458-205-7003
Practice Address - Fax:458-205-7042
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health