Healthcare Provider Details

I. General information

NPI: 1902231723
Provider Name (Legal Business Name): MRS. STEFANIE G ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 62ND AVE SE
OLYMPIA WA
98513-9204
US

IV. Provider business mailing address

9707 62ND AVE SE
OLYMPIA WA
98513-9204
US

V. Phone/Fax

Practice location:
  • Phone: 408-835-6368
  • Fax:
Mailing address:
  • Phone: 408-835-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN61447008
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: