Provider Demographics
NPI:1215231345
Name:ROMINE, IRMGARD JO (LPA)
Entity Type:Individual
Prefix:MS
First Name:IRMGARD
Middle Name:JO
Last Name:ROMINE
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3509
Mailing Address - Country:US
Mailing Address - Phone:907-474-0044
Mailing Address - Fax:907-474-0044
Practice Address - Street 1:3980 DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3509
Practice Address - Country:US
Practice Address - Phone:907-474-0044
Practice Address - Fax:907-474-0044
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLPA 611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical