Healthcare Provider Details

I. General information

NPI: 1750412375
Provider Name (Legal Business Name): STEPHANIE ANN GERDES LCSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN COSPELICH

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13925 INTERURBAN AVE S STE 120
TUKWILA WA
98168-5718
US

IV. Provider business mailing address

13925 INTERURBAN AVE S STE 120
TUKWILA WA
98168-5718
US

V. Phone/Fax

Practice location:
  • Phone: 206-948-0096
  • Fax:
Mailing address:
  • Phone: 206-948-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60400
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number61170400
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: