Provider Demographics
NPI:1013052034
Name:SLOAN, ROSA RENE' (LMP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:RENE'
Last Name:SLOAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:R.
Other - Middle Name:RENE'
Other - Last Name:SLOAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12629 SE 212TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2282
Mailing Address - Country:US
Mailing Address - Phone:253-797-2518
Mailing Address - Fax:
Practice Address - Street 1:12629 SE 212TH PL
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-2282
Practice Address - Country:US
Practice Address - Phone:253-797-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0207295OtherLABOR AND INDUSTRIES
WA1013052034OtherNPPES