Provider Demographics
NPI:1194018135
Name:ROSE, CAROLINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10313 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9103
Mailing Address - Country:US
Mailing Address - Phone:503-726-3726
Mailing Address - Fax:503-726-3727
Practice Address - Street 1:801 NW WALLULA AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5455
Practice Address - Country:US
Practice Address - Phone:503-726-3726
Practice Address - Fax:503-726-3727
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker