Healthcare Provider Details

I. General information

NPI: 1093632887
Provider Name (Legal Business Name): STORMY ROSE BRUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

21851 84TH AVE S STE 101
KENT WA
98032-1958
US

IV. Provider business mailing address

9501 VETERANS DR SW
LAKEWOOD WA
98498-1147
US

V. Phone/Fax

Practice location:
  • Phone: 425-947-2462
  • Fax:
Mailing address:
  • Phone: 360-560-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70127123
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: