Provider Demographics
NPI:1912755224
Name:WEDGEWORTH, STEPHANIE JEAN (BA, SUDPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:WEDGEWORTH
Suffix:
Gender:F
Credentials:BA, SUDPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:RYTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, SUDPT
Mailing Address - Street 1:2616 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9291
Mailing Address - Country:US
Mailing Address - Phone:360-213-2475
Mailing Address - Fax:360-384-2349
Practice Address - Street 1:2616 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9291
Practice Address - Country:US
Practice Address - Phone:360-312-2420
Practice Address - Fax:360-384-2349
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61336534101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)