Provider Demographics
NPI:1194149344
Name:STAGNARO, EVELYN (MM, MT-BC)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:STAGNARO
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 W PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-4120
Mailing Address - Country:US
Mailing Address - Phone:443-995-1975
Mailing Address - Fax:
Practice Address - Street 1:2339 W PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-4120
Practice Address - Country:US
Practice Address - Phone:443-995-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
FL10884225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist