Charleen Fitzgerald

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP 00004295 Issued in WA

Practice address

12812 101St Avenue CT E
Puyallup, WA 98373-9101

Phone

(253) 864-4770

Fax

(253) 864-4771

NPI assigned

Sep 25, 2014

Last updated

Sep 25, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411603200000",
    "number": "1578965182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17210 91ST AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983752235",
            "telephone_number": "253-222-5012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12812 101ST AVENUE CT E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983739101",
            "telephone_number": "253-864-4770",
            "fax_number": "253-864-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "CHARLEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-25",
        "last_updated": "2014-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP 00004295",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60323125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Fish, MD
• Michael Wesley Fish, LPN
• Susan H Fish, PA-C
• Karisa Brook Fisher, LMP
• Roberta Fisher, LMP
• Charlene Fitzgerald
• Emily Rachelle Fitzgerald
• Diana Rose Lomallo Fitzpatrick
• Courtney Marie Fjellman, L.M.P.
• Karl Ole Fjellstad, PA

• Addiction (Substance Use Disorder) Counselor in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.