Provider Demographics
NPI:1689072928
Name:SMITH, STEFANIE LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYNN
Last Name:SMITH
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 1:600 QUEEN ANNE AVENUE NORTH
Mailing Address - Street 2:DREAMCLINIC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-453-4137
Mailing Address - Fax:
Practice Address - Street 1:937 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2857
Practice Address - Country:US
Practice Address - Phone:917-747-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60321561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist