Provider Demographics
NPI:1558867242
Name:STEPHENS, DELORES K (ND)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:K
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2932
Mailing Address - Country:US
Mailing Address - Phone:256-244-4053
Mailing Address - Fax:
Practice Address - Street 1:16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4257
Practice Address - Country:US
Practice Address - Phone:503-658-7715
Practice Address - Fax:503-658-7181
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4153175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath