Healthcare Provider Details

I. General information

NPI: 1124179643
Provider Name (Legal Business Name): DEBORAH KATHLEEN FALK ROVANG M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 W REYNOLDS AVE
CENTRALIA WA
98531-4554
US

IV. Provider business mailing address

PO BOX 412
SHELTON WA
98584-0412
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9044
  • Fax:
Mailing address:
  • Phone: 360-426-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00051276
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: