Provider Demographics
NPI:1083802367
Name:ROSSMAN, MARK KEVIN (LISW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEVIN
Last Name:ROSSMAN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12269 TOWNSHIP ROAD 45
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9237
Mailing Address - Country:US
Mailing Address - Phone:419-957-9716
Mailing Address - Fax:
Practice Address - Street 1:12269 TOWNSHIP ROAD 45
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9237
Practice Address - Country:US
Practice Address - Phone:419-957-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI - 00047511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249243Medicaid