Provider Demographics
NPI:1336987791
Name:VANDENBERG, STEFANI (CHW)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37400 BELL ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7868
Mailing Address - Country:US
Mailing Address - Phone:971-220-2701
Mailing Address - Fax:503-210-8681
Practice Address - Street 1:37400 BELL ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7868
Practice Address - Country:US
Practice Address - Phone:971-220-2701
Practice Address - Fax:503-210-8681
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000111507172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker