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NPI Code Detail

MEDICARE: STEPHANIE BLACK DO

MEDICARE:   STEPHANIE  BLACK  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician17592AWY
22084P0802XAddiction Psychiatry PhysicianDO.OP.70017378WA

General Provider Information

NPI Number : 1437724002
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE BLACK DO
Provider Business Mailing Address
First Line : 1550 N 115TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98133-8401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1550 N 115TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98133-8401
Country : US
Telephone Number : 206-543-6577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2021
Last Update Date : 12/09/2025

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Directions to “ STEPHANIE BLACK DO” Practice Location

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