MEDICARE: MS. LAURIE PIA ROSTHOLDER LICSW, CEAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00005600	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3399RO	OTHER	WA	REGENCE
2	0005857041	OTHER	WA	AETNA

General Provider Information

NPI Number	:	1033322433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE PIA ROSTHOLDER LICSW, CEAP

Provider Business Mailing Address
First Line	:	9500 ROOSEVELT WAY N.E.
Second Line	:	SUITE 206
City	:	SEATTLE
State	:	WA
Zip	:	98115-2253
Country	:	US
Telephone Number	:	206-523-1677
Fax Number	:	206-517-8113

Provider Business Practice Location Address
First Line	:	9500 ROOSEVELT WAY N.E.
Second Line	:	SUITE 206
City	:	SEATTLE
State	:	WA
Zip	:	98115-2253
Country	:	US
Telephone Number	:	206-523-1677
Fax Number	:	206-517-8113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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