Healthcare Provider Details

I. General information

NPI: 1265366033
Provider Name (Legal Business Name): STEPHANIE SUMMERS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S 56TH ST STE 302
TACOMA WA
98409-6900
US

IV. Provider business mailing address

917 WOODHOLLOW LN
CEDAR PARK TX
78613-4536
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-0343
  • Fax: 253-627-0343
Mailing address:
  • Phone: 360-551-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUP.AC.70050402
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: