Provider Demographics
NPI:1699801902
Name:KUFFEL, STEPHANIE W (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:W
Last Name:KUFFEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 S LAMONTE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:628 S MAPLE ST STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3445
Practice Address - Country:US
Practice Address - Phone:509-456-7888
Practice Address - Fax:509-838-7679
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2929103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY2929OtherSTATE LICENSE NUMBER
WA201315123OtherTAX ID NUMBER
WA2929KUMedicare UPIN