Provider Demographics
NPI:1902780778
Name:ROODE, CLORISSA M
Entity type:Individual
Prefix:
First Name:CLORISSA
Middle Name:M
Last Name:ROODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 AUBURN WAY N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1381
Mailing Address - Country:US
Mailing Address - Phone:425-246-7038
Mailing Address - Fax:253-354-0039
Practice Address - Street 1:4508 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1381
Practice Address - Country:US
Practice Address - Phone:425-246-7038
Practice Address - Fax:253-354-0039
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician