Healthcare Provider Details

I. General information

NPI: 1396008959
Provider Name (Legal Business Name): DELENE R RODENBERG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/04/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20110 VASHON HIGHWAY SW
VASHON WA
98070
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-227-8832
  • Fax:
Mailing address:
  • Phone: 206-548-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLF61453299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: