Provider Demographics
NPI:1598458721
Name:ROSALES, EMERALD JACKILYN DANIELLE
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:JACKILYN DANIELLE
Last Name:ROSALES
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 1:348 TURRET DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-3341
Mailing Address - Country:US
Mailing Address - Phone:720-431-2290
Mailing Address - Fax:
Practice Address - Street 1:348 TURRET DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-3341
Practice Address - Country:US
Practice Address - Phone:720-431-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health