Provider Demographics
NPI:1609243740
Name:SHANLEE STEPHENS
Entity Type:Organization
Organization Name:SHANLEE STEPHENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-314-6781
Mailing Address - Street 1:1603 E LAKESHORE DR
Mailing Address - Street 2:APT 3
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 95TH DR NE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7976
Practice Address - Country:US
Practice Address - Phone:425-334-9137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60548922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty