Healthcare Provider Details

I. General information

NPI: 1144707308
Provider Name (Legal Business Name): MICHELLE GAY ROGERS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 1ST AVE N STE 205
SEATTLE WA
98109-2301
US

IV. Provider business mailing address

2318 FAIRVIEW AVE E UNIT 3
SEATTLE WA
98102-3346
US

V. Phone/Fax

Practice location:
  • Phone: 425-652-9850
  • Fax:
Mailing address:
  • Phone: 425-652-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60868955
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: