Provider Demographics
NPI:1265034508
Name:FRISTAD, RODGER DALE (INTERPRETER)
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:DALE
Last Name:FRISTAD
Suffix:
Gender:M
Credentials:INTERPRETER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATE ROUTE 150 SPC 60
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:WA
Mailing Address - Zip Code:98831-9060
Mailing Address - Country:US
Mailing Address - Phone:509-433-8543
Mailing Address - Fax:
Practice Address - Street 1:1000 STATE ROUTE 150 SPC 60
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:WA
Practice Address - Zip Code:98831-9060
Practice Address - Country:US
Practice Address - Phone:509-433-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4582171R00000X
WASC12066171R00000X
WAMC56081171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter