Provider Demographics
NPI:1548879661
Name:TROGER, DOLORES
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:TROGER
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 1:9123 AUTUMN LINE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6052
Mailing Address - Country:US
Mailing Address - Phone:360-480-3234
Mailing Address - Fax:
Practice Address - Street 1:9123 AUTUMN LINE LOOP SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-6052
Practice Address - Country:US
Practice Address - Phone:360-480-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602641351171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9056OtherWA DSHS CERTIFICATE