Provider Demographics
NPI:1861039091
Name:STENSVAD, HIIAKA VARUA
Entity type:Individual
Prefix:
First Name:HIIAKA
Middle Name:VARUA
Last Name:STENSVAD
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 1:6704 SE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5624
Mailing Address - Country:US
Mailing Address - Phone:503-706-1226
Mailing Address - Fax:
Practice Address - Street 1:6637 SE MILWAUKIE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5658
Practice Address - Country:US
Practice Address - Phone:503-706-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC-5428103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling