Provider Demographics
NPI:1639518889
Name:STONE, DOREEN SUE (QMHA)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:SUE
Last Name:STONE
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 FALCON ST
Mailing Address - Street 2:SPACE 59
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1501
Mailing Address - Country:US
Mailing Address - Phone:541-879-0355
Mailing Address - Fax:
Practice Address - Street 1:1005 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7448
Practice Address - Country:US
Practice Address - Phone:541-774-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator