Provider Demographics
NPI:1427316264
Name:PRICE, STEFANIE DARLENE (MA60253608)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:DARLENE
Last Name:PRICE
Suffix:
Gender:F
Credentials:MA60253608
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11405 26TH PL SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-5186
Mailing Address - Country:US
Mailing Address - Phone:425-397-7429
Mailing Address - Fax:
Practice Address - Street 1:534 WESTLAKE AVE N
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4305
Practice Address - Country:US
Practice Address - Phone:206-718-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60253608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist