Provider Demographics
NPI:1164690970
Name:SCHULTZ, ROSALYN (PHD)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 BONHOMME AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1908
Mailing Address - Country:US
Mailing Address - Phone:314-862-8070
Mailing Address - Fax:314-862-0077
Practice Address - Street 1:7711 BONHOMME AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1908
Practice Address - Country:US
Practice Address - Phone:314-862-8070
Practice Address - Fax:314-862-0077
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist