Provider Demographics
NPI:1760557854
Name:STANFIELD, GERRI RAVYN (LAC)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:RAVYN
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 NE CLACKAMAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4919
Mailing Address - Country:US
Mailing Address - Phone:503-754-8802
Mailing Address - Fax:
Practice Address - Street 1:4050 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1828
Practice Address - Country:US
Practice Address - Phone:503-754-8802
Practice Address - Fax:503-662-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
ORAC00806171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty