STACY L MANDZIJ (NPI# 1659890887) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659890887 |
| Entity Type | Individual |
| Full Name | STACY L MANDZIJ |
| Other Name | STACIA L MANDZIJ |
| Credential | LCSW |
| Practice Address |
1310 Sw 17th Ave Portland OR 97201-2522 |
| Mailing Address |
1776 Sw Madison St Portland OR 97205-1715 |
| Practice Telephone | 5032312641 |
| Practice Fax Number | 5034674077 |
| Mailing Telephone | 9713862278 |
| Mailing Fax Number | 5032244494 |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2020-10-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 104100000X | Social Worker | L8570 | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500734958 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1631 Sw Columbia St, Portland, OR 972016025 | 5032312641 | 5032311654 |
| Street Address |
1310 SW 17TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97201-2522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164756722 | Amy A Thompson | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2009-09-29 |
| 1972127025 | Kristin A Schwing | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2020-06-04 |
| 1306473962 | Joanna Marie Jones | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2020-03-24 |
| 1962067470 | Jean Michelle Stonebraker | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2019-05-09 |
| 1053882829 | Kay M Cockerill | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2018-12-05 |
| 1245746742 | Tonya M Jones | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-12-19 |
| 1316477441 | Patrick G Eagle Staff | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-06-12 |
| 1699203851 | Angelique S Saxton | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-05-31 |
| 1447701305 | Lindsey R Miller | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2016-10-17 |
| 1801242730 | Tanya L Black | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2016-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780206060 | Laura Elizabeth Jackson | Student in an Organized Health Care Education/Training Program | 2730 S Moody Ave, Portland, OR 97201 | 2020-05-10 |
| 1225659063 | Amanpreet Kaur | Student in an Organized Health Care Education/Training Program | Ohsu Physician Assistant Program, 2730 South Moody Ave. Mail Code: Cl5pa, Portland, OR 97201 | 2020-05-04 |
| 1063033801 | Aaron Kinn | Student in an Organized Health Care Education/Training Program | Ohsu Division of Physician Assistant Education - Cl5pa, 2730 Sw Moody Avenue, Portland, OR 97201 | 2020-05-04 |
| 1487275442 | Erin Aleen Ostlie-madden | Student in an Organized Health Care Education/Training Program | 2730 South Moody Ave, Portland, OR 97201 | 2020-04-30 |
| 1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
| 1740825587 | Dalia Bayaa | Pharmacist | 325 Sw Harrison Street, Portland, OR 97201 | 2019-11-15 |
| 1780172619 | Susan Elizabeth Christian Barrios | Social Worker | 1505 Sw College St, Portland, OR 97201 | 2018-04-26 |
| 1730696576 | Fiona Everett | Counselor | 1703 Sw Clay St, Portland, OR 97201 | 2018-01-02 |
| 1437678844 | Akira Thomas Neilsen | Student in an Organized Health Care Education/Training Program | 1930 Sw River Drive, Unit 102, Portland, OR 97201 | 2017-09-18 |
| 1285171736 | Howard Mitchell | Technician, Other | 1110 Sw Clay Street Apt. 34, Portland, OR 97201 | 2017-01-23 |
| Find all providers in zip 97201 | ||||
| Taxonomy Code | 104100000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. |
| Notes: Source: National Association of Social Workers, 2009 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750980389 | Shayla Lee Adkins | Social Worker | 5530 Se 72nd Ave, Portland, OR 97206-5207 | 2020-10-24 |
| 1386242154 | Michael Harris | Social Worker | 87 Glenwood Ave, Portland, ME 04103-3128 | 2020-10-14 |
| 1245844141 | Dane Hilts | Social Worker | 5524 Se Hawthorne Blvd, Portland, OR 97215-3368 | 2020-09-08 |
| 1073131462 | Corinne J Allen | Social Worker | 14678 Nw Cornell Rd Apt 52, Portland, OR 97229-7407 | 2020-07-11 |
| 1831715176 | Darnell Jackie Strong | Social Worker | 435 Ne 78th Ave 'strong Counseling Services', Portland, OR 97213 | 2020-06-23 |
| 1376168906 | Connor Brown | Social Worker | 738 Ne Davis St, Portland, OR 97232-2931 | 2020-06-09 |
| 1770110041 | Oriana Korol | Social Worker | 811 Ne 92nd Ave, Portland, OR 97220-4513 | 2020-03-25 |
| 1366080988 | Matthew Emerson Schultz | Social Worker | 314 Sw 9th Ave, Portland, OR 97205-2802 | 2019-12-13 |
| 1831749985 | Rachel Petke | Social Worker | 2800 N Vancouver Ave Ste 207, Portland, OR 97227-1630 | 2019-09-19 |
| 1639722390 | Jenna Su Morgan Wing | Social Worker | 905 Sw Cedar Hills Blvd Apt 1312, Portland, OR 97225-5772 | 2019-07-22 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.