Healthcare Provider Details

I. General information

NPI: 1982175592
Provider Name (Legal Business Name): CHRISTINA ROCHELLE STORY HAGER CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1600 S LANE ST
SEATTLE WA
98144-2810
US

IV. Provider business mailing address

4500 HARBOUR POINTE BLVD APT 203
MUKILTEO WA
98275-4717
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-2371
  • Fax:
Mailing address:
  • Phone: 425-286-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCO60702122
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: