Healthcare Provider Details

I. General information

NPI: 1871668251
Provider Name (Legal Business Name): DONNA BEDGOOD ROSEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MEYER ST
KETTLE FALLS WA
99141
US

IV. Provider business mailing address

PO BOX 757
KETTLE FALLS WA
99141-0757
US

V. Phone/Fax

Practice location:
  • Phone: 509-738-4490
  • Fax: 509-738-4490
Mailing address:
  • Phone: 509-738-4490
  • Fax: 509-738-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00004156
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: