Healthcare Provider Details

I. General information

NPI: 1083524078
Provider Name (Legal Business Name): FREDA CHANA EDWARDS-ROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4227 S MERIDIAN STE D
PUYALLUP WA
98373-3603
US

IV. Provider business mailing address

4227 S MERIDIAN STE D #395
PUYALLUP WA
98373-3603
US

V. Phone/Fax

Practice location:
  • Phone: 253-344-2098
  • Fax:
Mailing address:
  • Phone: 253-344-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: