Provider Demographics
NPI:1184833600
Name:WEDLUND, STEPHANIE JEANMARIE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:JEANMARIE
Last Name:WEDLUND
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 1:27034 SE RAVENSDALE PL
Mailing Address - Street 2:
Mailing Address - City:RAVENSDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98051-8100
Mailing Address - Country:US
Mailing Address - Phone:206-396-1421
Mailing Address - Fax:
Practice Address - Street 1:27034 SE RAVENSDALE PL
Practice Address - Street 2:
Practice Address - City:RAVENSDALE
Practice Address - State:WA
Practice Address - Zip Code:98051-8100
Practice Address - Country:US
Practice Address - Phone:206-396-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist