Provider Demographics
NPI:1821771544
Name:ROSE, LAQUITA ROSHAWN (RSW)
Entity Type:Individual
Prefix:
First Name:LAQUITA
Middle Name:ROSHAWN
Last Name:ROSE
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14924 FOREST GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-4228
Mailing Address - Country:US
Mailing Address - Phone:225-229-6389
Mailing Address - Fax:
Practice Address - Street 1:14924 FOREST GROVE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-4228
Practice Address - Country:US
Practice Address - Phone:225-229-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator