Provider Demographics
NPI:1558534206
Name:ROGERS, LYDIA B
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:B
Last Name:ROGERS
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 1:1206 E JEFFERSON ST UNIT 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5588
Mailing Address - Country:US
Mailing Address - Phone:206-283-7059
Mailing Address - Fax:
Practice Address - Street 1:1206 E JEFFERSON ST UNIT 208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5588
Practice Address - Country:US
Practice Address - Phone:206-283-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60496382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional