Provider Demographics
NPI:1760121172
Name:ROSSMILLER, THEA JUSTINE (MSW)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:JUSTINE
Last Name:ROSSMILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTMINSTER PL STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-5511
Mailing Address - Country:US
Mailing Address - Phone:847-919-9096
Mailing Address - Fax:
Practice Address - Street 1:1 WESTMINSTER PL STE 101
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-5511
Practice Address - Country:US
Practice Address - Phone:847-919-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health