Provider Demographics
NPI:1548521735
Name:KARDOS, STEPHANIE (LAC, LMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KARDOS
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 1ST AVE N # B10
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2301
Mailing Address - Country:US
Mailing Address - Phone:206-414-8115
Mailing Address - Fax:
Practice Address - Street 1:2120 1ST AVE N # B10
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2301
Practice Address - Country:US
Practice Address - Phone:206-414-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61370049171100000X
WA60344647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist