Basic Information
| Provider Information | |||||||||
| NPI: | 1386695153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 NORTH SHORE DRIVE | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982264414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606766000 | ||||||||
| FaxNumber: | 3606766006 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 NORTH SHORE DRIVE | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982264414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606766000 | ||||||||
| FaxNumber: | 3606766006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00053081 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7043615 | 05 | WA | MEDICAID |