Provider Demographics
NPI:1285004838
Name:TRAYLOR, ROSELYN JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:ROSELYN
Middle Name:JEAN
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21710 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2692
Mailing Address - Country:US
Mailing Address - Phone:313-680-0626
Mailing Address - Fax:
Practice Address - Street 1:21710 CHURCH ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2692
Practice Address - Country:US
Practice Address - Phone:313-680-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010466561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical