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General NPI Number Information
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NPI Number | 1114153715
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Entity Type | Individual
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Provider Name | KEN TOMAS ROSE
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Gender | Male
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 950 BROADWAY STE 404
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City | TACOMA
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State | WA
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Zip | 98402-4454
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Country | US
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Telephone | 206-774-8557
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Fax | 253-697-3730
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Provider Business Mailing Address
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Address Line | 33405 8TH AVE S UNIT 200
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6639
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Country | US
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Telephone | 253-409-4148
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Fax | 253-661-8644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC61002732
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License Number State | WA
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