Healthcare Provider Details

I. General information

NPI: 1124790530
Provider Name (Legal Business Name): STEPHANIE L BECKER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 N 26TH ST
TACOMA WA
98407-6305
US

IV. Provider business mailing address

2912 N 26TH ST
TACOMA WA
98407-6305
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-1624
  • Fax:
Mailing address:
  • Phone: 412-508-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW70002185
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: