Provider Demographics
NPI:1568623627
Name:RIDDIFORD, STEPHANIE ALEXANDRA (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALEXANDRA
Last Name:RIDDIFORD
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 1:6738 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5507
Mailing Address - Country:US
Mailing Address - Phone:206-789-0289
Mailing Address - Fax:866-670-3206
Practice Address - Street 1:6738 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5507
Practice Address - Country:US
Practice Address - Phone:206-789-0289
Practice Address - Fax:866-670-3206
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00023808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist