Provider Demographics
NPI:1871826453
Name:SWEZEY, STEPHANIE DAWN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:SWEZEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0805
Mailing Address - Country:US
Mailing Address - Phone:509-429-1866
Mailing Address - Fax:509-846-1005
Practice Address - Street 1:670 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-846-1000
Practice Address - Fax:509-846-1005
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA60025362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist