Provider Demographics
NPI:1144925983
Name:KING, STEPHANIE JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JANE
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 36TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3104
Mailing Address - Country:US
Mailing Address - Phone:206-715-9067
Mailing Address - Fax:
Practice Address - Street 1:19217 36TH AVE W STE 215
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5754
Practice Address - Country:US
Practice Address - Phone:206-715-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301387103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist