Provider Demographics
NPI:1356010284
Name:DOBRY-RIORDAN, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:DOBRY-RIORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4046
Mailing Address - Country:US
Mailing Address - Phone:541-891-1541
Mailing Address - Fax:
Practice Address - Street 1:1741 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4621
Practice Address - Country:US
Practice Address - Phone:541-891-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-10-20
Deactivation Date:2021-09-13
Deactivation Code:
Reactivation Date:2021-10-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator