Basic Information
| Provider Information | |||||||||
| NPI: | 1295156685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARDIFF | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E OLIVE ST. | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538768983 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4238 AUBURN WAY N | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980021311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538767600 | ||||||||
| FaxNumber: | 2538767610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2014 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MG60472284 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.