Active NPI
Ken Tomas Rose
- Clinical Social Worker
- Tacoma, WA
National Provider Identifier
1114153715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SC61002732
- Practice address
- 950 Broadway Ste 404
Tacoma, WA 98402-4454 - Phone
- (206) 774-8557
- Fax
- (253) 697-3730
- NPI assigned
- Jun 9, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SC61002732 | WA | Primary |
Addresses
Primary practice location
950 Broadway Ste 404
Tacoma, WA 98402-4454
Mailing address
33405 8TH Ave S Unit 200
Federal Way, WA 98003-6639
Phone (253) 409-4148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC61002732 | WA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Therapy Group PC | Mental Health | Current | Accepting new patients |
Locations
950 Broadway
Ste 404
Tacoma, WA 98402
Phone (206) 774-8557
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745539200000",
"number": "1114153715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33405 8TH AVE S UNIT 200",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980036639",
"telephone_number": "253-409-4148",
"fax_number": "253-661-8644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 BROADWAY STE 404",
"city": "TACOMA",
"state": "WA",
"postal_code": "984024454",
"telephone_number": "206-774-8557",
"fax_number": "253-697-3730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "KEN",
"middle_name": "TOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-09",
"last_updated": "2025-04-25",
"certification_date": "2025-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "SC61002732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.