Provider Demographics
NPI:1891042859
Name:DAVIS, STEPHANIE ANN (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2182
Mailing Address - Country:US
Mailing Address - Phone:206-320-5325
Mailing Address - Fax:206-320-5326
Practice Address - Street 1:4515 MARTIN LUTHER KING JR WAY S
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2182
Practice Address - Country:US
Practice Address - Phone:206-320-5325
Practice Address - Fax:206-320-5326
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical