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General NPI Number Information
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NPI Number | 1841728870
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Entity Type | Individual
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Provider Name | MR. ROGER ROBERT BAERWOLF
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Gender | Male
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Dates
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Enumeration Date | 06/04/2017
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 1300 114TH AVE SE STE 104
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City | BELLEVUE
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State | WA
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Zip | 98004-6928
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Country | US
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Telephone | 425-616-3800
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Fax | 425-217-0162
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Provider Business Mailing Address
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Address Line | PO BOX 343
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City | WOODINVILLE
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State | WA
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Zip | 98072-0343
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Country | US
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Telephone | 425-877-5636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC60684326
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License Number State | WA
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