Provider Demographics
NPI:1518477215
Name:ROETHE, REINA
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:ROETHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19817 DRY SLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-9548
Mailing Address - Country:US
Mailing Address - Phone:503-894-2469
Mailing Address - Fax:
Practice Address - Street 1:1151 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5245
Practice Address - Country:US
Practice Address - Phone:425-349-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health