1922470145 NPI number — LAURA ROGSTAD PSYD

Table of content: JOHN JOSEPH MACHATA MD (NPI 1922064534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922470145 NPI number — LAURA ROGSTAD PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGSTAD
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARING
Provider Other First Name:
LAURA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922470145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1709 124TH AVE NE UNIT 53
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE STEVENS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98258-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-451-7245
Provider Business Mailing Address Fax Number:
206-237-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 124TH AVE NE UNIT 53
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-451-7245
Provider Business Practice Location Address Fax Number:
206-237-9229
Provider Enumeration Date:
10/27/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY60743589 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)