Healthcare Provider Details

I. General information

NPI: 1205765864
Provider Name (Legal Business Name): PATRICK ROBERT STEPHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 SW FOREST ST
SEATTLE WA
98116-2925
US

IV. Provider business mailing address

5126 SW FOREST ST
SEATTLE WA
98116-2925
US

V. Phone/Fax

Practice location:
  • Phone: 207-659-1994
  • Fax:
Mailing address:
  • Phone: 207-659-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.61580346
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: