Provider Demographics
NPI:1407016975
Name:CLAKE, STEVEN S (LMP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:CLAKE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14692 179TH AVE SE STE 400
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1160
Mailing Address - Country:US
Mailing Address - Phone:360-863-0960
Mailing Address - Fax:360-863-8710
Practice Address - Street 1:14692 179TH AVE SE STE 400
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1160
Practice Address - Country:US
Practice Address - Phone:360-863-0960
Practice Address - Fax:360-863-8710
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist