Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 104100000X | Social Worker | LW61177852 | WA |
NPI | 1003271313 |
---|---|
Provider Name | Tara Rose |
First Address | Renton, WA 98057-2617 |
Second Address | Portland, OR 97239-3939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2015 |
Last Update Date | 01/12/2021 |