Provider Demographics
NPI:1932616471
Name:SINON, STACY DAWN
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DAWN
Last Name:SINON
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 1:2810 RIVER RD S APT B
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9735
Mailing Address - Country:US
Mailing Address - Phone:971-273-6422
Mailing Address - Fax:
Practice Address - Street 1:1320 MERIDIAN DR
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9668
Practice Address - Country:US
Practice Address - Phone:503-498-5476
Practice Address - Fax:503-498-5810
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health