Healthcare Provider Details

I. General information

NPI: 1942609326
Provider Name (Legal Business Name): STEPHANIE LUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 W MCGRAW ST STE 306
SEATTLE WA
98199-3239
US

IV. Provider business mailing address

3214 W MCGRAW ST STE 306
SEATTLE WA
98199-3239
US

V. Phone/Fax

Practice location:
  • Phone: 206-453-4882
  • Fax:
Mailing address:
  • Phone: 206-453-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCG60501220
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number274519866
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: