Provider Demographics
NPI:1700081064
Name:STIPE, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:STIPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S 296TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3627
Mailing Address - Country:US
Mailing Address - Phone:253-927-6616
Mailing Address - Fax:
Practice Address - Street 1:33919 9TH AVE S
Practice Address - Street 2:201
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6742
Practice Address - Country:US
Practice Address - Phone:253-927-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist