Provider Demographics
NPI:1497220941
Name:MONROE, STACI RENAE (OTD)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:RENAE
Last Name:MONROE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:RENAE
Other - Last Name:BIELENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3519
Mailing Address - Country:US
Mailing Address - Phone:503-263-8903
Mailing Address - Fax:503-266-8632
Practice Address - Street 1:2274 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5597
Practice Address - Country:US
Practice Address - Phone:971-261-2159
Practice Address - Fax:503-883-9782
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR41084225X00000X
101Y00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor