Provider Demographics
NPI:1992747687
Name:WHITCHURCH, STEPHANIE LYNN (LAC,MACOM)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:WHITCHURCH
Suffix:
Gender:F
Credentials:LAC,MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:154 SE 103RD AVE
Mailing Address - Street 2:APT. M112
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2385
Mailing Address - Country:US
Mailing Address - Phone:503-998-4014
Mailing Address - Fax:
Practice Address - Street 1:615 SE CHKALOV DR
Practice Address - Street 2:SUITE 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5279
Practice Address - Country:US
Practice Address - Phone:360-885-1767
Practice Address - Fax:360-885-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 00002377171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist