Healthcare Provider Details

I. General information

NPI: 1235480021
Provider Name (Legal Business Name): STEPHANIE LYNN YANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S LANE ST.
SEATTLE WA
98144-9814
US

IV. Provider business mailing address

PO BOX 249
SNOW HILL MD
21863-0249
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-3073
  • Fax:
Mailing address:
  • Phone: 410-632-1100
  • Fax: 410-632-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSC60749018
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: