Provider Demographics
NPI:1649747387
Name:ROSBOROUGH, HANNAH GRACE (CDP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:ROSBOROUGH
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 1:19435 68TH AVE S BLDG S STE 109
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:425-251-1933
Mailing Address - Fax:425-251-4996
Practice Address - Street 1:19435 68TH AVE S BLDG S STE 109
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032
Practice Address - Country:US
Practice Address - Phone:425-251-1933
Practice Address - Fax:425-251-4996
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60753393101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)