Provider Demographics
NPI:1538290697
Name:STARR, STEPHANIE A (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:STARR
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 1:16107 44TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-3878
Mailing Address - Country:US
Mailing Address - Phone:253-538-7912
Mailing Address - Fax:
Practice Address - Street 1:212 S 37TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7801
Practice Address - Country:US
Practice Address - Phone:253-475-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist