Healthcare Provider Details

I. General information

NPI: 1356004816
Provider Name (Legal Business Name): TIERRA RUFFIN CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 4TH AVE
SEATTLE WA
98104-1108
US

IV. Provider business mailing address

827 W VALLEY HWY TRLR 65
KENT WA
98032-2953
US

V. Phone/Fax

Practice location:
  • Phone: 206-887-3782
  • Fax:
Mailing address:
  • Phone: 850-207-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.70116791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: