Basic Information
| Provider Information | |||||||||
| NPI: | 1134782352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONELAKE | ||||||||
| FirstName: | HANNA | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3312 SW 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972392915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415135348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3990 COLLINS WAY STE 202 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970353459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036752830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | OR | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | L8034 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.