Provider Demographics
NPI:1376003202
Name:BOOK, ROSELLA LEEANN
Entity Type:Individual
Prefix:
First Name:ROSELLA
Middle Name:LEEANN
Last Name:BOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N BASIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-9639
Mailing Address - Country:US
Mailing Address - Phone:618-516-5326
Mailing Address - Fax:615-516-5325
Practice Address - Street 1:407 N BASIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9639
Practice Address - Country:US
Practice Address - Phone:618-516-3526
Practice Address - Fax:618-516-3525
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health