Healthcare Provider Details

I. General information

NPI: 1013579895
Provider Name (Legal Business Name): STEFANIE JASWAL CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13116 NE 132ND ST
KIRKLAND WA
98034-2306
US

IV. Provider business mailing address

13116 NE 132ND ST
KIRKLAND WA
98034-2306
US

V. Phone/Fax

Practice location:
  • Phone: 425-292-0743
  • Fax:
Mailing address:
  • Phone: 425-292-0743
  • 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 StateWA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: