Provider Demographics
NPI:1457152894
Name:IVES, ROWAN (AAC)
Entity type:Individual
Prefix:
First Name:ROWAN
Middle Name:
Last Name:IVES
Suffix:
Gender:
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S 330TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5909
Mailing Address - Country:US
Mailing Address - Phone:818-481-8504
Mailing Address - Fax:
Practice Address - Street 1:1011 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6779
Practice Address - Country:US
Practice Address - Phone:360-770-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health