Provider Demographics
NPI:1063224525
Name:JANKOWSKI, STEPHANIE SUTPHIN (LICSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUTPHIN
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 RAM CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1547
Mailing Address - Country:US
Mailing Address - Phone:360-890-6500
Mailing Address - Fax:
Practice Address - Street 1:430 RAM CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1547
Practice Address - Country:US
Practice Address - Phone:360-890-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW61522079171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator