Provider Demographics
NPI:1710391164
Name:SMITH, ROSANNA (MA, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14551 JUDICIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4991
Mailing Address - Country:US
Mailing Address - Phone:952-898-5020
Mailing Address - Fax:952-898-5858
Practice Address - Street 1:14551 JUDICIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4991
Practice Address - Country:US
Practice Address - Phone:952-898-5020
Practice Address - Fax:952-898-5858
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072366101YM0800X
MN01917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health