Individual provider Active NPI

Elizabeth Marie Roloson

  • Peer Specialist
  • Longview, WA
National Provider Identifier
1871229765
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
CG61336173 Issued in WA
Practice address
1116 14TH Ave
Longview, WA 98632-3017
Phone
(360) 506-1324
NPI assigned
Jul 25, 2022
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X CG61336173 WA Primary

Addresses

Primary practice location

1116 14TH Ave
Longview, WA 98632-3017

Mailing address

1116 14TH Ave
Longview, WA 98632-3017
Phone (360) 506-1324

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CG61336173WAMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Integrated Health Services, LLC Peer Specialist CurrentSince Sep 14, 2022 Accepting new patients

Locations

1116 14th Ave
Longview, WA 98632
Phone (360) 669-3863

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1871229765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323017",
            "telephone_number": "360-506-1324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323017",
            "telephone_number": "360-506-1324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLOSON",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WA",
            "license": "CG61336173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.