Provider Demographics
NPI:1609418813
Name:MASON, STEPHANIE AMANDA ANN (MB PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:AMANDA ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:MB PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E PINE ST APT 401N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3394
Mailing Address - Country:US
Mailing Address - Phone:206-295-0836
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVENUE, MAIL STOP #359796
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-295-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program