Provider Demographics
NPI:1891088928
Name:UPCHURCH, STEPHANIE (LMP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1526
Mailing Address - Country:US
Mailing Address - Phone:425-522-2571
Mailing Address - Fax:
Practice Address - Street 1:108 E MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1526
Practice Address - Country:US
Practice Address - Phone:425-522-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60206948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist