Provider Demographics
NPI:1154474799
Name:KOWALS, STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KOWALS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 FAIRVIEW AVE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3051
Mailing Address - Country:US
Mailing Address - Phone:206-324-4500
Mailing Address - Fax:206-328-1257
Practice Address - Street 1:3123 FAIRVIEW AVE E
Practice Address - Street 2:SUITE E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3051
Practice Address - Country:US
Practice Address - Phone:206-324-4500
Practice Address - Fax:206-328-1257
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000321632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG03310Medicare UPIN