Provider Demographics
NPI:1477267169
Name:WASHINGTON, STEFANY KRYSTYNE (CHT)
Entity Type:Individual
Prefix:
First Name:STEFANY
Middle Name:KRYSTYNE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6384 MACKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3347
Mailing Address - Country:US
Mailing Address - Phone:313-212-4244
Mailing Address - Fax:
Practice Address - Street 1:6384 MACKENZIE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-3347
Practice Address - Country:US
Practice Address - Phone:313-212-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0122339175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath