Provider Demographics
NPI:1336163302
Name:BURLINGAME, ROCHELLE L (LMP)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:L
Last Name:BURLINGAME
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 1:479 CAIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9583
Mailing Address - Country:US
Mailing Address - Phone:360-595-0361
Mailing Address - Fax:
Practice Address - Street 1:1050 LARRABEE AVE
Practice Address - Street 2:STE 201
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7367
Practice Address - Country:US
Practice Address - Phone:360-927-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021869174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist