Provider Demographics
NPI:1942363163
Name:ROTHMAN, CHERYL ANN (MED)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14163
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98511-4163
Mailing Address - Country:US
Mailing Address - Phone:360-538-2958
Mailing Address - Fax:
Practice Address - Street 1:403 W STATE ST STE 205
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6140
Practice Address - Country:US
Practice Address - Phone:360-538-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health