Healthcare Provider Details

I. General information

NPI: 1982147559
Provider Name (Legal Business Name): MISS KATIE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 FEDERAL AVE BUILDINGS 1
EVERETT WA
98203-2132
US

IV. Provider business mailing address

9 W MARILYN AVE
EVERETT WA
98204-2729
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-8480
  • Fax:
Mailing address:
  • Phone: 425-446-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberROGERKG071LQ
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberROGERKG071LQ
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: