Provider Demographics
NPI:1407620990
Name:LEWIS, STEFANI (LSWAIC)
Entity Type:Individual
Prefix:MISS
First Name:STEFANI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 100TH ST SE STE A2
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3832
Mailing Address - Country:US
Mailing Address - Phone:425-312-0277
Mailing Address - Fax:425-312-0280
Practice Address - Street 1:1920 100TH ST SE STE A2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3832
Practice Address - Country:US
Practice Address - Phone:425-312-0277
Practice Address - Fax:425-312-0280
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61484455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health