Provider Demographics
NPI:1467242248
Name:FARENIK, STEPHANIE CHRISTINA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTINA
Last Name:FARENIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4713
Mailing Address - Country:US
Mailing Address - Phone:541-286-5002
Mailing Address - Fax:
Practice Address - Street 1:139 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4713
Practice Address - Country:US
Practice Address - Phone:541-286-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN316321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical