Provider Demographics
NPI:1730306796
Name:STEPHENS, MARILYN (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:STEPHENS
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 1:431 NW 100TH PL
Mailing Address - Street 2:#116
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4950
Mailing Address - Country:US
Mailing Address - Phone:206-295-7239
Mailing Address - Fax:
Practice Address - Street 1:1800 NW MARKET ST
Practice Address - Street 2:200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3900
Practice Address - Country:US
Practice Address - Phone:206-781-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022541171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor