Provider Demographics
NPI:1437688553
Name:KIZZIAR, STEFFANI LORRAINE (PSYD)
Entity type:Individual
Prefix:
First Name:STEFFANI
Middle Name:LORRAINE
Last Name:KIZZIAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 JUDSON ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5309
Mailing Address - Country:US
Mailing Address - Phone:415-847-0746
Mailing Address - Fax:
Practice Address - Street 1:698 12TH ST SE STE 145
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4076
Practice Address - Country:US
Practice Address - Phone:415-847-0746
Practice Address - Fax:415-847-0746
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical