Provider Demographics
NPI:1538358692
Name:STALLINGS, CHEYENNE RENEE' (LMP)
Entity type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:RENEE'
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD
Mailing Address - Street 2:#117
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8514
Mailing Address - Country:US
Mailing Address - Phone:360-265-9667
Mailing Address - Fax:
Practice Address - Street 1:15398 SEABECK HWY NW
Practice Address - Street 2:
Practice Address - City:SEABECK
Practice Address - State:WA
Practice Address - Zip Code:98380-8704
Practice Address - Country:US
Practice Address - Phone:360-265-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist