Provider Demographics
NPI:1538132410
Name:PIEPER, ROSANN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSANN
Middle Name:MARIE
Last Name:PIEPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27520 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8781
Mailing Address - Country:US
Mailing Address - Phone:360-834-3705
Mailing Address - Fax:
Practice Address - Street 1:1104 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2999
Practice Address - Country:US
Practice Address - Phone:360-993-5352
Practice Address - Fax:360-735-9116
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115000741Medicare ID - Type Unspecified