Provider Demographics
NPI:1669595807
Name:GROGAN, STACIE LEE (LMP)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LEE
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
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Mailing Address - Street 1:4604 STIKES DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5972
Mailing Address - Country:US
Mailing Address - Phone:253-223-0945
Mailing Address - Fax:360-923-4810
Practice Address - Street 1:11108 WOODLAND AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5893
Practice Address - Country:US
Practice Address - Phone:253-845-5358
Practice Address - Fax:253-845-5753
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00013641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist