Provider Demographics
NPI:1245271246
Name:STUNTZNER, DENISE E (LCSW)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:E
Last Name:STUNTZNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CENTRAL AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2342
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0635514OtherNORTH BEND MEDICAL CENTER GROUP TAX ID
OR161133OtherNORTH BEND MEDICAL CENTER GROUP MEDICAID
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE
OR1407812365OtherNORTH BEND MEDICAL CENTER GROUP NPI