Healthcare Provider Details

I. General information

NPI: 1437724002
Provider Name (Legal Business Name): STEPHANIE BLACK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-6577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17592A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberDO.OP.70017378
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: