Provider Demographics
NPI:1497384762
Name:ROSEMA, PHYLICIA ROCHELLE
Entity Type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:ROCHELLE
Last Name:ROSEMA
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 1:8486 88TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9059
Mailing Address - Country:US
Mailing Address - Phone:616-633-1970
Mailing Address - Fax:
Practice Address - Street 1:4507 170TH AVE
Practice Address - Street 2:
Practice Address - City:HERSEY
Practice Address - State:MI
Practice Address - Zip Code:49639-8785
Practice Address - Country:US
Practice Address - Phone:231-305-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099010104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker