Provider Demographics
NPI:1033322433
Name:ROSTHOLDER, LAURIE PIA (LICSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:PIA
Last Name:ROSTHOLDER
Suffix:
Gender:F
Credentials:LICSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ROOSEVELT WAY N.E.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2253
Mailing Address - Country:US
Mailing Address - Phone:206-523-1677
Mailing Address - Fax:206-517-8113
Practice Address - Street 1:9500 ROOSEVELT WAY N.E.
Practice Address - Street 2:SUITE 206
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2253
Practice Address - Country:US
Practice Address - Phone:206-523-1677
Practice Address - Fax:206-517-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000056001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3399ROOtherREGENCE
WA0005857041OtherAETNA
WAAB19937Medicare ID - Type Unspecified