Provider Demographics
NPI:1639920721
Name:STUTZMAN, MANDY (CRM, PSS, PWS)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:CRM, PSS, PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 NE 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4222
Mailing Address - Country:US
Mailing Address - Phone:503-875-1350
Mailing Address - Fax:
Practice Address - Street 1:200 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1200
Practice Address - Country:US
Practice Address - Phone:503-235-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-2840175T00000X
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist