Provider Demographics
NPI:1376946582
Name:STEPHANIE K FARRELL ND, LLC
Entity Type:Organization
Organization Name:STEPHANIE K FARRELL ND, LLC
Other - Org Name:STEPHANIE FARRELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-446-5820
Mailing Address - Street 1:PO BOX 25763
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0763
Mailing Address - Country:US
Mailing Address - Phone:503-446-5820
Mailing Address - Fax:503-208-8033
Practice Address - Street 1:5201 SW WESTGATE DR BLDG B
Practice Address - Street 2:# 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2412
Practice Address - Country:US
Practice Address - Phone:503-446-5820
Practice Address - Fax:503-208-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1604175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty