Provider Demographics
NPI:1841412665
Name:ROWLETTE, DEVONNA RAE (SUDP)
Entity Type:Individual
Prefix:MRS
First Name:DEVONNA
Middle Name:RAE
Last Name:ROWLETTE
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:MS
Other - First Name:DEVONNA
Other - Middle Name:RAE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4840 JOURNEY
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6779
Mailing Address - Country:US
Mailing Address - Phone:360-413-2727
Mailing Address - Fax:360-455-4620
Practice Address - Street 1:1305 MANSFIELD ST STE 5
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-942-1624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00046179101YA0400X
WACP00006429101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)