Provider Demographics
NPI:1326295601
Name:KOHNKE, ROSE (MA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:KOHNKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S PANTANO RD
Mailing Address - Street 2:249
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4132
Mailing Address - Country:US
Mailing Address - Phone:520-302-0328
Mailing Address - Fax:
Practice Address - Street 1:260 S PANTANO RD
Practice Address - Street 2:249
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4132
Practice Address - Country:US
Practice Address - Phone:520-302-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health