Healthcare Provider Details

I. General information

NPI: 1154474799
Provider Name (Legal Business Name): STEPHANIE KOWALS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 FAIRVIEW AVE E SUITE E
SEATTLE WA
98102-3051
US

IV. Provider business mailing address

3123 FAIRVIEW AVE E SUITE E
SEATTLE WA
98102-3051
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-4500
  • Fax: 206-328-1257
Mailing address:
  • Phone: 206-324-4500
  • Fax: 206-328-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00032163
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: