Provider Demographics
NPI:1497967590
Name:BROOK, STEPHANIE BARROW (LMP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BARROW
Last Name:BROOK
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:PO BOX 4607
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-4607
Mailing Address - Country:US
Mailing Address - Phone:509-430-3214
Mailing Address - Fax:
Practice Address - Street 1:5025 N ROAD 68
Practice Address - Street 2:SUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9175
Practice Address - Country:US
Practice Address - Phone:509-430-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist