Stephanie Spak, LPC, LMHC, CADC 1

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C1392 Issued in OR

Practice address

2929 SW Multnomah Blvd
Suite 304
Portland, OR 97219-4025

Phone

(503) 452-0240

NPI assigned

May 2, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1326260282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 SW MULTNOMAH BLVD",
            "address_2": "SUITE 304",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972194025",
            "telephone_number": "503-452-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 SW MULTNOMAH BLVD",
            "address_2": "SUITE 304",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972194025",
            "telephone_number": "503-452-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAK",
        "first_name": "STEPHANIE",
        "name_prefix": "Ms.",
        "credential": "LPC, LMHC, CADC 1",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "99-11-44",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00010972",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C1392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madelyn Josephine Spain, M.S.E.D.
• Megan Spain
• Michael Spain
• Rebecca Spain, MD
• Tommie Spain
• Marguerite Pingrey Spake, L.M.T.
• Shelby Harlan Spake, MA, LMFT
• Emilie Spalding
• Hallie Spalding, RDN, LDN
• Kelly Ann Span, CADC I

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.