Provider Demographics
NPI:1710369244
Name:ROLOSON, CIARA
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:ROLOSON
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 1:6182 N 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2479
Mailing Address - Country:US
Mailing Address - Phone:614-783-1036
Mailing Address - Fax:
Practice Address - Street 1:6182 N 89TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2479
Practice Address - Country:US
Practice Address - Phone:614-783-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst