Provider Demographics
NPI:1477604072
Name:ROSE, KAREN LISELLE (BA, SUDP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LISELLE
Last Name:ROSE
Suffix:
Gender:F
Credentials:BA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NE HAMPE WAY
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2403
Mailing Address - Country:US
Mailing Address - Phone:360-345-6709
Mailing Address - Fax:
Practice Address - Street 1:151 NE HAMPE WAY
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2403
Practice Address - Country:US
Practice Address - Phone:360-345-6790
Practice Address - Fax:360-242-2501
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001463101YA0400X
WA60164137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)