Provider Demographics
NPI:1235746785
Name:SAWYER, STEPHANIE MARIE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:SAWYER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:HAWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:4160 6TH AVE SE STE 104
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1039
Mailing Address - Country:US
Mailing Address - Phone:360-456-4756
Mailing Address - Fax:360-960-8315
Practice Address - Street 1:512 W YELM AVE UNIT A
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8773
Practice Address - Country:US
Practice Address - Phone:360-960-8316
Practice Address - Fax:360-960-8315
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60667209237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist