Provider Demographics
NPI:1356491880
Name:GOW, STACY LYNN (AAC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:GOW
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FAWCETT AVE APT 40
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5600
Mailing Address - Country:US
Mailing Address - Phone:253-337-9272
Mailing Address - Fax:
Practice Address - Street 1:902 FAWCETT AVE APT 40
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5600
Practice Address - Country:US
Practice Address - Phone:253-327-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022309225700000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist