Provider Demographics
NPI:1871854356
Name:IRISH, ERICA ROCHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROCHELLE
Last Name:IRISH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 EVERGREEN WAY
Mailing Address - Street 2:601
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2062
Mailing Address - Country:US
Mailing Address - Phone:360-835-9911
Mailing Address - Fax:
Practice Address - Street 1:3307 EVERGREEN WAY
Practice Address - Street 2:601
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2062
Practice Address - Country:US
Practice Address - Phone:360-835-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60270543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist