Provider Demographics
NPI:1447317193
Name:STOEBER, AMY W (PHD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:STOEBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 SE SUNNYSIDE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5746
Mailing Address - Country:US
Mailing Address - Phone:503-653-5205
Mailing Address - Fax:503-653-5219
Practice Address - Street 1:10001 SE SUNNYSIDE RD STE 140
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5746
Practice Address - Country:US
Practice Address - Phone:503-653-5205
Practice Address - Fax:503-653-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1667103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent