Provider Demographics
NPI:1194557850
Name:GROGAN, ISABELLE ROSA (MC61588552)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:ROSA
Last Name:GROGAN
Suffix:
Gender:F
Credentials:MC61588552
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14803 130TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2828
Mailing Address - Country:US
Mailing Address - Phone:253-533-5471
Mailing Address - Fax:
Practice Address - Street 1:11416 SLATER AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4600
Practice Address - Country:US
Practice Address - Phone:206-589-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61588552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health