1043298102 NPI number — COLUMBIA COUNTY FIRE DIST 3

Table of content: ERICA DENISE LODGEN MA, LMFT (NPI 1912042847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043298102 NPI number — COLUMBIA COUNTY FIRE DIST 3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA COUNTY FIRE DIST 3
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043298102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-394-7030
Provider Business Mailing Address Fax Number:
360-394-7097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 W MAIN ST
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99328-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-382-4281
Provider Business Practice Location Address Fax Number:
509-382-2845
Provider Enumeration Date:
01/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
509-382-4281

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  07D03 , 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)

  • Identifier: 8376CO . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9056771 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0143925 . This is a "L&I AND CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 807654000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00242339 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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