Provider Demographics
NPI:1356491880
Name:GOW, STACY LYNN (LMP)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:GOW
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 1:12412 MILITARY RD E
Mailing Address - Street 2:APT 3
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-3610
Mailing Address - Country:US
Mailing Address - Phone:253-337-9272
Mailing Address - Fax:
Practice Address - Street 1:12412 MILITARY RD E
Practice Address - Street 2:APT 3
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-3610
Practice Address - Country:US
Practice Address - Phone:253-337-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist