Provider Demographics
NPI:1871994178
Name:MITCHELL, STACY CLAIRE MCDOWELL
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:CLAIRE MCDOWELL
Last Name:MITCHELL
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 1:10915 296TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-9029
Mailing Address - Country:US
Mailing Address - Phone:425-761-5703
Mailing Address - Fax:
Practice Address - Street 1:465 RAINIER BLVD N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2826
Practice Address - Country:US
Practice Address - Phone:425-392-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60493074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist