Provider Demographics
NPI:1083987739
Name:JEFFORDS, STEPHANNE D (LMP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANNE
Middle Name:D
Last Name:JEFFORDS
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 1:3021 NE 72ND DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-260-6903
Mailing Address - Fax:
Practice Address - Street 1:3021 NE 72ND DR
Practice Address - Street 2:SUITE 15
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7300
Practice Address - Country:US
Practice Address - Phone:360-260-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60257372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist