Provider Demographics
NPI:1205813417
Name:KINERK, ROSE F (MW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:F
Last Name:KINERK
Suffix:
Gender:F
Credentials:MW
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:F
Other - Last Name:KALLENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-1082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:913 S PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1845
Practice Address - Country:US
Practice Address - Phone:573-729-6222
Practice Address - Fax:573-729-0094
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker