Provider Demographics
NPI:1174779052
Name:KORFF, STEPHANIE
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:KORFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28710 OLD RAINIER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-2301
Mailing Address - Country:US
Mailing Address - Phone:503-791-7417
Mailing Address - Fax:
Practice Address - Street 1:28710 OLD RAINIER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2301
Practice Address - Country:US
Practice Address - Phone:503-791-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X
WA60010456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional