Provider Demographics
NPI:1124422464
Name:WRIGHT, STEPHANIE ANN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:WRIGHT
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 1:1417 NW 54TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3572
Mailing Address - Country:US
Mailing Address - Phone:206-929-9749
Mailing Address - Fax:206-681-9996
Practice Address - Street 1:1417 NW 54TH ST STE 215
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3572
Practice Address - Country:US
Practice Address - Phone:206-929-9749
Practice Address - Fax:206-681-9996
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60736580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA813792293OtherITINS