Provider Demographics
NPI:1841187259
Name:NEUROROOTED THERAPY, PLLC
Entity type:Organization
Organization Name:NEUROROOTED THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LSWAIC
Authorized Official - Phone:206-659-1624
Mailing Address - Street 1:7553 28TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4537
Mailing Address - Country:US
Mailing Address - Phone:206-659-1624
Mailing Address - Fax:206-971-9532
Practice Address - Street 1:7553 28TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4537
Practice Address - Country:US
Practice Address - Phone:206-659-1624
Practice Address - Fax:206-971-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty