MEDICARE: DR. ANN MARIE ROEPKE PH.D.

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	103TC0700X	Clinical Psychologist	PY60720638	WA

General Provider Information

NPI Number	:	1073084935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN MARIE ROEPKE PH.D.

Provider Business Mailing Address
First Line	:	1702 S BAYVIEW ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-5123
Country	:	US
Telephone Number	:	267-901-4183
Fax Number	:

Provider Business Practice Location Address
First Line	:	4741 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1657
Country	:	US
Telephone Number	:	267-901-4183
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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