Provider Demographics
NPI:1427129113
Name:BOES-ROSSI, MANDY L (RC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:BOES-ROSSI
Suffix:
Gender:F
Credentials:RC
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:L
Other - Last Name:BOES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:MS 359107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:CAMPUS BOX 356125
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-8202
Practice Address - Fax:206-598-6333
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health