Provider Demographics
NPI:1669693222
Name:ENNIS, STEPHANIE KAYS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KAYS
Last Name:ENNIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:KAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 NINTH AVE, DEPT OF PHYSICAL MEDICINE & REHAP(H4-PM
Mailing Address - Street 2:VIRGINIA MASON MEDICAL CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 NINTH AVE
Practice Address - Street 2:VIRGINIA MASON MEDICAL CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-341-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2540154235Z00000X
WALL60032975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8567869Medicaid
WA8899341Medicare PIN
WA8567869Medicaid