Provider Demographics
NPI:1740798057
Name:ROSA, EMILIE KAYE
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:KAYE
Last Name:ROSA
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 1:3381 HATHAWAY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9740
Mailing Address - Country:US
Mailing Address - Phone:517-914-3736
Mailing Address - Fax:
Practice Address - Street 1:3425 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5052
Practice Address - Country:US
Practice Address - Phone:517-782-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional