Provider Demographics
NPI:1932758224
Name:DR. STACIE ROWAN, LLC
Entity Type:Organization
Organization Name:DR. STACIE ROWAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:LEE FISHELL
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-337-5301
Mailing Address - Street 1:132 E BROADWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3154
Mailing Address - Country:US
Mailing Address - Phone:541-337-5301
Mailing Address - Fax:844-671-7143
Practice Address - Street 1:132 E BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3154
Practice Address - Country:US
Practice Address - Phone:541-337-5301
Practice Address - Fax:844-671-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty