Provider Demographics
NPI:1306630827
Name:RUVALCABA, STEPHENIE L
Entity type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:L
Last Name:RUVALCABA
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 1:2413 BURCHAM ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-5140
Mailing Address - Country:US
Mailing Address - Phone:360-977-3558
Mailing Address - Fax:
Practice Address - Street 1:2413 BURCHAM ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-5140
Practice Address - Country:US
Practice Address - Phone:360-977-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605572988-001-0001171W00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist