Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP60106906 | WA |
N | 104100000X | Social Worker | LW60127918 | WA |
Y | 1041C0700X | Clinical Social Worker | LW60127918 | WA |
NPI | 1013074954 |
---|---|
Provider Name | Miss Roza Cathrina Bockelman |
First Address | Puyallup, WA 98372-3265 |
Second Address | Puyallup, WA 98372-3265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 11/08/2014 |