Provider Demographics
NPI:1750676151
Name:KROUSE, ROSE M (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:M
Last Name:KROUSE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:ELLERBROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:541 SR 664 N SUITE C
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:44313
Practice Address - Country:US
Practice Address - Phone:740-385-6594
Practice Address - Fax:740-774-6617
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16007281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.1600728OtherLICENSE