Provider Demographics
NPI:1184932030
Name:TEAHN, STEPHANIE R (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:TEAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-974-0997
Mailing Address - Fax:503-716-4632
Practice Address - Street 1:117 NW 8TH STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-974-0997
Practice Address - Fax:503-716-4632
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ORL105941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500685732Medicaid