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General NPI Number Information
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NPI Number | 1861884470
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Entity Type | Individual
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Provider Name | TANYA ELAINE STEPHENSON LICSW, SUDP
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Gender | Female
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 4238 AUBURN WAY N
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City | AUBURN
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State | WA
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Zip | 98002-1311
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Country | US
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Telephone | 206-901-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 19620 96TH ST E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61147514
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP60098046
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License Number State | WA
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