Provider Demographics
NPI:1982096764
Name:MARTINEZ, STEPHANIE LOUISE (CADC II)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1557
Mailing Address - Country:US
Mailing Address - Phone:503-591-9280
Mailing Address - Fax:503-848-2072
Practice Address - Street 1:4585 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-1557
Practice Address - Country:US
Practice Address - Phone:503-591-9280
Practice Address - Fax:503-848-2072
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OR18-02-25101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)