1124157953 NPI number — MRS. ERIN STEPHANIE ROHDE SLP

Table of content: MRS. ERIN STEPHANIE ROHDE SLP (NPI 1124157953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124157953 NPI number — MRS. ERIN STEPHANIE ROHDE SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROHDE
Provider First Name:
ERIN
Provider Middle Name:
STEPHANIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POWAZEK
Provider Other First Name:
ERIN
Provider Other Middle Name:
STEPHANIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124157953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 GLEN VALLEY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-400-5653
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4560 SE INTERNATIONAL WAY SUITE 100
Provider Second Line Business Practice Location Address:
CONSONUS HEALTHCARE SERVICES
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-206-5129
Provider Business Practice Location Address Fax Number:
971-206-5209
Provider Enumeration Date:
03/05/2007

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: 235Z00000X , with the licence number:  14039 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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