Healthcare Provider Details

I. General information

NPI: 1588493761
Provider Name (Legal Business Name): STEPHANIE WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECCHI DRIVE 4S148
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DRIVE 4S148
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-2718
  • Fax:
Mailing address:
  • Phone: 801-213-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: