Healthcare Provider Details

I. General information

NPI: 1184460206
Provider Name (Legal Business Name): NICOLE ROSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 NE 50TH ST
SEATTLE WA
98105-3342
US

IV. Provider business mailing address

2102 NE 50TH ST
SEATTLE WA
98105-3342
US

V. Phone/Fax

Practice location:
  • Phone: 502-303-5160
  • Fax:
Mailing address:
  • Phone: 502-303-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61691873
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA70012260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: