Healthcare Provider Details

I. General information

NPI: 1124385497
Provider Name (Legal Business Name): ROSE ANN RHODES SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W SUITE 102
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

PO BOX 5194
LYNNWOOD WA
98046-5194
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-1538
  • Fax: 425-774-5171
Mailing address:
  • Phone: 425-774-1538
  • Fax: 425-774-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60273729
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: