Provider Demographics
NPI:1134340367
Name:HILL, STACY S (LMP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:S
Last Name:HILL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:S
Other - Last Name:PEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:202 164TH ST SW # 4
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8189
Mailing Address - Country:US
Mailing Address - Phone:206-229-6789
Mailing Address - Fax:425-513-1960
Practice Address - Street 1:202 164TH ST SW
Practice Address - Street 2:SUITE 4
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8189
Practice Address - Country:US
Practice Address - Phone:206-229-6789
Practice Address - Fax:425-523-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMO00007444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist