MEDICARE: MS. DEBRA PATTON ROOD MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00009152	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LW00009152	OTHER	WA	LICENSE NUMBER

General Provider Information

NPI Number	:	1962575084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA PATTON ROOD MSW, LICSW

Provider Business Mailing Address
First Line	:	2330 EASTGATE ST, NORTH
Second Line	:	STE 205
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-3080
Country	:	US
Telephone Number	:	509-301-7252
Fax Number	:	509-522-2330

Provider Business Practice Location Address
First Line	:	2330 EASTGATE ST, NORTH
Second Line	:	STE 205
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2557
Country	:	US
Telephone Number	:	509-301-7252
Fax Number	:	509-522-2330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	05/19/2014

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