Provider Demographics
NPI:1841578366
Name:COLLINS, STEPHANIE M (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:COLLINS
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 1:3416 BROADWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5082
Mailing Address - Country:US
Mailing Address - Phone:425-275-1767
Mailing Address - Fax:
Practice Address - Street 1:3416 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5082
Practice Address - Country:US
Practice Address - Phone:425-275-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60230433225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist