Provider Demographics
NPI:1679193304
Name:ROSAS, YESICA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:YESICA
Middle Name:
Last Name:ROSAS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8927 W TUCANNON AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7176
Mailing Address - Country:US
Mailing Address - Phone:509-537-6394
Mailing Address - Fax:
Practice Address - Street 1:8927 W TUCANNON AVE STE 107
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7176
Practice Address - Country:US
Practice Address - Phone:509-537-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60277892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health