Provider Demographics
NPI:1518407220
Name:DENNY, ROSANNE MARIE
Entity Type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:MARIE
Last Name:DENNY
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 1:605 CADILLAC SHORES DR APT 106
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2690
Mailing Address - Country:US
Mailing Address - Phone:231-920-8474
Mailing Address - Fax:
Practice Address - Street 1:605 CADILLAC SHORES DR #106
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-920-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician