Provider Demographics
NPI:1376974873
Name:SWEETWATER, ROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:SWEETWATER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW 9TH ST #110
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-768-6770
Mailing Address - Fax:541-768-9771
Practice Address - Street 1:815 NW 9TH ST #110
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-768-6770
Practice Address - Fax:541-768-9771
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL51691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical