Healthcare Provider Details

I. General information

NPI: 1730121328
Provider Name (Legal Business Name): TERRI P ROCKWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 TALBOT RD S
RENTON WA
98055-6219
US

IV. Provider business mailing address

4445 TALBOT RD S
RENTON WA
98055-6219
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4055
  • Fax: 425-656-5425
Mailing address:
  • Phone: 425-656-4055
  • Fax: 425-656-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00008150
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: