Provider Demographics
NPI:1467663138
Name:FLAMM, ROSEANNE IRENE (LISW)
Entity Type:Individual
Prefix:MS
First Name:ROSEANNE
Middle Name:IRENE
Last Name:FLAMM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 95TH AVE W
Mailing Address - Street 2:
Mailing Address - City:TAYLOR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:61284-9801
Mailing Address - Country:US
Mailing Address - Phone:309-798-2960
Mailing Address - Fax:563-355-4110
Practice Address - Street 1:2213 E 52ND ST
Practice Address - Street 2:STE. B
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2785
Practice Address - Country:US
Practice Address - Phone:563-355-4410
Practice Address - Fax:563-355-4110
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA011751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical