Provider Demographics
NPI:1073136743
Name:SCHULTZ, ROSEANN MARIE (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:MARIE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BROADWAY AVE N STE 106
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4144
Mailing Address - Country:US
Mailing Address - Phone:507-951-8517
Mailing Address - Fax:507-824-4048
Practice Address - Street 1:1700 BROADWAY AVE N STE 106
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4144
Practice Address - Country:US
Practice Address - Phone:507-951-8517
Practice Address - Fax:507-824-4048
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
922105065OtherIRS