Provider Demographics
NPI:1831436161
Name:ROSTAD, FREDRICA A
Entity type:Individual
Prefix:
First Name:FREDRICA
Middle Name:A
Last Name:ROSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WASHINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-8404
Mailing Address - Country:US
Mailing Address - Phone:360-893-2246
Mailing Address - Fax:
Practice Address - Street 1:320 WASHINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-8404
Practice Address - Country:US
Practice Address - Phone:360-893-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA273193C103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist