Healthcare Provider Details

I. General information

NPI: 1104743079
Provider Name (Legal Business Name): MS. ROCHELLE RENEE STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 S 216TH ST APT 428
DES MOINES WA
98198-4323
US

IV. Provider business mailing address

721 FAWCETT AVE
TACOMA WA
98402-5502
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-2413
  • Fax: 253-627-4817
Mailing address:
  • Phone: 253-593-2413
  • Fax: 253-627-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO.70107082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: