Provider Demographics
NPI:1497905285
Name:STEFFEN, JODI RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:RENEE
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 46TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-6005
Mailing Address - Country:US
Mailing Address - Phone:503-385-7300
Mailing Address - Fax:503-873-3034
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:503-362-1002
Practice Address - Fax:503-362-1006
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11831OtherL.M.T.