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NPI Code Detail

MEDICARE: DEBORAH KATHLEEN FALK ROVANG M.ED

MEDICARE: DEBORAH KATHLEEN FALK ROVANG M.ED
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
1101Y00000XCounselorRC00051276WA

General Provider Information

NPI Number : 1124179643
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH KATHLEEN FALK ROVANG M.ED
Provider Business Mailing Address
First Line : PO BOX 412
Second Line :
City : SHELTON
State : WA
Zip : 98584-0412
Country : US
Telephone Number : 360-426-9682
Fax Number :
Provider Business Practice Location Address
First Line : 2428 W REYNOLDS AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-4554
Country : US
Telephone Number : 360-330-9044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/08/2007

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