Provider Demographics
NPI:1215150206
Name:LENZ, STEPHANIE ROCHELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROCHELLE
Last Name:LENZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ROCHELLE
Other - Last Name:MCGILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 NE 146TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8006
Mailing Address - Country:US
Mailing Address - Phone:503-995-5254
Mailing Address - Fax:
Practice Address - Street 1:3716 SE INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-659-0073
Practice Address - Fax:503-659-7471
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist