Provider Demographics
NPI:1962575084
Name:ROOD, DEBRA PATTON (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:PATTON
Last Name:ROOD
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 1:2330 EASTGATE ST, NORTH
Mailing Address - Street 2:STE 205
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3080
Mailing Address - Country:US
Mailing Address - Phone:509-301-7252
Mailing Address - Fax:509-522-2330
Practice Address - Street 1:2330 EASTGATE ST, NORTH
Practice Address - Street 2:STE 205
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2557
Practice Address - Country:US
Practice Address - Phone:509-301-7252
Practice Address - Fax:509-522-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000091521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00009152OtherLICENSE NUMBER