Provider Demographics
NPI:1477799047
Name:RIBAS, STEPHANIE LYNN (MT-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:RIBAS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12029
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-0029
Mailing Address - Country:US
Mailing Address - Phone:503-284-6794
Mailing Address - Fax:
Practice Address - Street 1:2430 NE 9TH AVE
Practice Address - Street 2:APT. 5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4107
Practice Address - Country:US
Practice Address - Phone:561-254-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator