Individual
STEPHANIE IDA KENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1201 S PROCTOR ST, TACOMA, WA 98405-2047
(253) 396-5800
Mailing address
1201 S PROCTOR ST, TACOMA, WA 98405-2047
(253) 396-5800
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
RN61024617
WA
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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