Provider Demographics
NPI:1255181863
Name:ESKEW, STEPHANIE CORANN (CMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CORANN
Last Name:ESKEW
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 N CASTLE ROCK ST SPC 17
Mailing Address - Street 2:
Mailing Address - City:WOODLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93286-1144
Mailing Address - Country:US
Mailing Address - Phone:559-280-6623
Mailing Address - Fax:
Practice Address - Street 1:690 N CASTLE ROCK ST SPC 17
Practice Address - Street 2:
Practice Address - City:WOODLAKE
Practice Address - State:CA
Practice Address - Zip Code:93286-1144
Practice Address - Country:US
Practice Address - Phone:805-253-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist