Provider Demographics
NPI:1801330808
Name:ROHDE, ETHAN (ND, LAC)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:ROHDE
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 4TH AVE # 95
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-9997
Mailing Address - Country:US
Mailing Address - Phone:206-636-1116
Mailing Address - Fax:866-275-5509
Practice Address - Street 1:721 4TH AVE # 95
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-9997
Practice Address - Country:US
Practice Address - Phone:206-636-1116
Practice Address - Fax:866-275-5509
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60728734171100000X
WANT60707712175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist