MEDICARE: DR. ROGENE M. EICHLER WEST PHD QEEGD BCN CC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0500X	EEG Specialist/Technologist		WA
2	101Y00000X	Counselor	CL60528100	WA

General Provider Information

NPI Number	:	1609328731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGENE M. EICHLER WEST PHD QEEGD BCN CC

Provider Business Mailing Address
First Line	:	219 1ST AVE S
Second Line	:	SUITE 310
City	:	SEATTLE
State	:	WA
Zip	:	98104-2575
Country	:	US
Telephone Number	:	206-456-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 1ST AVE S STE 310
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2551
Country	:	US
Telephone Number	:	206-456-5454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	12/18/2019

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