Healthcare Provider Details

I. General information

NPI: 1780089003
Provider Name (Legal Business Name): ROSE MARIE BALDRIDGE CP60235875
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W GOWE ST
KENT WA
98032-5892
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax: 253-661-8631
Mailing address:
  • Phone: 206-408-5236
  • Fax: 253-835-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60235875
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAC.CQ.61529172
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: