Provider Demographics
NPI:1467591131
Name:COMERS, ROSONNA SUE (LCSW CADCIII)
Entity Type:Individual
Prefix:
First Name:ROSONNA
Middle Name:SUE
Last Name:COMERS
Suffix:
Gender:F
Credentials:LCSW CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 OSHKOSH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902
Mailing Address - Country:US
Mailing Address - Phone:920-410-6047
Mailing Address - Fax:920-929-9142
Practice Address - Street 1:N6687 WRIGHTWAY DR
Practice Address - Street 2:STE D
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937
Practice Address - Country:US
Practice Address - Phone:920-929-9140
Practice Address - Fax:920-929-9142
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70031231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39386100Medicaid