Provider Demographics
NPI:1871628511
Name:LILJESTRAND, STEPHANIE L (LMP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:LILJESTRAND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:15 E CENTRAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1109
Mailing Address - Country:US
Mailing Address - Phone:509-487-5717
Mailing Address - Fax:509-487-0207
Practice Address - Street 1:15 E CENTRAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1109
Practice Address - Country:US
Practice Address - Phone:509-487-5717
Practice Address - Fax:509-487-5717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014349225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist