Provider Demographics
NPI:1508104308
Name:MEAD, ROSE ANN (CDP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANN
Last Name:MEAD
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:USK
Mailing Address - State:WA
Mailing Address - Zip Code:99180-0067
Mailing Address - Country:US
Mailing Address - Phone:509-789-7630
Mailing Address - Fax:509-445-0646
Practice Address - Street 1:934 S GARFIELD RD
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9030
Practice Address - Country:US
Practice Address - Phone:509-789-7630
Practice Address - Fax:509-445-0646
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60076419261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder