Provider Demographics
NPI:1851031843
Name:WADSWORTH, STEPHANIE (CPM, LDM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7085 BATTLE CREEK RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9395
Mailing Address - Country:US
Mailing Address - Phone:859-302-2555
Mailing Address - Fax:503-967-7600
Practice Address - Street 1:7085 BATTLE CREEK RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9395
Practice Address - Country:US
Practice Address - Phone:859-302-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10221360176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife