Healthcare Provider Details

I. General information

NPI: 1548738800
Provider Name (Legal Business Name): JONATHAN TAYLOR ROOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

IV. Provider business mailing address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-5200
  • Fax:
Mailing address:
  • Phone: 509-525-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSC61315201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: