Provider Demographics
NPI:1013148287
Name:HERINGER, STEPHANIE (LMP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HERINGER
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 1:23500 39TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8278
Mailing Address - Country:US
Mailing Address - Phone:425-770-7015
Mailing Address - Fax:
Practice Address - Street 1:8004 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2653
Practice Address - Country:US
Practice Address - Phone:425-353-1011
Practice Address - Fax:425-353-1033
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist