Provider Demographics
NPI:1922470145
Name:ROGSTAD, LAURA (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROGSTAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1709 124TH AVE NE UNIT 53
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1802
Mailing Address - Country:US
Mailing Address - Phone:206-451-7245
Mailing Address - Fax:206-237-9229
Practice Address - Street 1:1709 124TH AVE NE UNIT 53
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1802
Practice Address - Country:US
Practice Address - Phone:206-451-7245
Practice Address - Fax:206-237-9229
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60743589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist