Provider Demographics
NPI:1609939891
Name:RAE, COSETTE DAWNA (LSWAIC, NCTMB, LMP,)
Entity Type:Individual
Prefix:
First Name:COSETTE
Middle Name:DAWNA
Last Name:RAE
Suffix:
Gender:F
Credentials:LSWAIC, NCTMB, LMP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 290TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-7403
Mailing Address - Country:US
Mailing Address - Phone:425-222-3706
Mailing Address - Fax:888-788-3419
Practice Address - Street 1:1001 290TH AVE SE
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024-7403
Practice Address - Country:US
Practice Address - Phone:425-222-3706
Practice Address - Fax:888-788-3419
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019579225700000X
WASC601060471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1609939891OtherPREMERA