Healthcare Provider Details

I. General information

NPI: 1083020945
Provider Name (Legal Business Name): RODSLYN C.E. KING SUD P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8271
TACOMA WA
98419-0271
US

IV. Provider business mailing address

PO BOX 8271
TACOMA WA
98419-0271
US

V. Phone/Fax

Practice location:
  • Phone: 253-310-8693
  • Fax: 253-310-8693
Mailing address:
  • Phone: 253-310-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP6045039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: