Provider Demographics
NPI:1578843082
Name:STEWART, ADRIEL JEANNE (LMP)
Entity Type:Individual
Prefix:
First Name:ADRIEL
Middle Name:JEANNE
Last Name:STEWART
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 1:1227 S 136TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2861
Mailing Address - Country:US
Mailing Address - Phone:253-709-5701
Mailing Address - Fax:
Practice Address - Street 1:9455 35TH AVE SW STE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3898
Practice Address - Country:US
Practice Address - Phone:206-932-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60247103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist