Provider Demographics
NPI:1396971735
Name:LANGE, STACY LEE (MSW,LCSW,CADCII)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LEE
Last Name:LANGE
Suffix:
Gender:F
Credentials:MSW,LCSW,CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 BOONES FERRY RD STE 700C
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3469
Mailing Address - Country:US
Mailing Address - Phone:503-888-2758
Mailing Address - Fax:503-635-9127
Practice Address - Street 1:15100 BOONES FERRY RD STE 700C
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-888-2758
Practice Address - Fax:503-635-9127
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-10-83101YA0400X
OR41641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)