Provider Demographics
NPI:1255795944
Name:STAMBACK, HILARY ARDEA (LMP)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:ARDEA
Last Name:STAMBACK
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 1:9714 3RD AVE NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2044
Mailing Address - Country:US
Mailing Address - Phone:206-841-2508
Mailing Address - Fax:
Practice Address - Street 1:9714 3RD AVE NE
Practice Address - Street 2:SUITE 140
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2044
Practice Address - Country:US
Practice Address - Phone:206-841-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60536669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist