Provider Demographics
NPI:1891982393
Name:STEADMAN, JENNIFER STAR
Entity Type:Individual
Prefix:PROF
First Name:JENNIFER
Middle Name:STAR
Last Name:STEADMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 WYNOOCHE AVE W
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-4210
Mailing Address - Country:US
Mailing Address - Phone:360-580-1043
Mailing Address - Fax:
Practice Address - Street 1:1402 WYNOOCHE AVE W
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-4210
Practice Address - Country:US
Practice Address - Phone:360-580-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022898174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist