Provider Demographics
NPI:1689760548
Name:NEILL, STEPHANIE ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:NEILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13901 NE 175TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8548
Mailing Address - Country:US
Mailing Address - Phone:206-810-5745
Mailing Address - Fax:425-486-7165
Practice Address - Street 1:13901 NE 175TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8548
Practice Address - Country:US
Practice Address - Phone:206-810-5745
Practice Address - Fax:425-486-7165
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001569103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANE4750OtherREGENCE