Provider Demographics
NPI:1306988928
Name:SNOW, STEPHANIE A (MS, LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SNOW
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 SW HERMOSO WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8684
Mailing Address - Country:US
Mailing Address - Phone:503-345-3260
Mailing Address - Fax:503-345-3052
Practice Address - Street 1:7555 SW HERMOSO WAY STE 120
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8684
Practice Address - Country:US
Practice Address - Phone:503-345-3260
Practice Address - Fax:503-345-3052
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC-4141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500785920Medicaid
OR500656380Medicaid