Basic Information
Provider Information | |||||||||
NPI: | 1841445392 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREGOIRE | ||||||||
FirstName: | ROCHELLE | ||||||||
MiddleName: | RENEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | A.A.S., HIS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 350 | ||||||||
Address2: |   | ||||||||
City: | MAPLE VALLEY | ||||||||
State: | WA | ||||||||
PostalCode: | 980380350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4253580956 | ||||||||
FaxNumber: | 8774816931 | ||||||||
Practice Location | |||||||||
Address1: | 1901 S UNION AVE | ||||||||
Address2: | STE. B-2001 | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984051702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2532723090 | ||||||||
FaxNumber: | 2536271415 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/25/2008 | ||||||||
LastUpdateDate: | 08/18/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA 60010599 | WA | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
No ID Information.