Healthcare Provider Details

I. General information

NPI: 1033190822
Provider Name (Legal Business Name): STEPHANIE LOIS LEONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LOIS FOSTER MD

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1700
US

IV. Provider business mailing address

9040 JACKSON AVENUE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3885
  • Fax:
Mailing address:
  • Phone: 808-778-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11706
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-11706
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: