Provider Demographics
NPI:1295285369
Name:ROSALES, BIANCA MARLENE (BSHS)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:MARLENE
Last Name:ROSALES
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 21ST STREET RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-6087
Mailing Address - Country:US
Mailing Address - Phone:970-714-9587
Mailing Address - Fax:
Practice Address - Street 1:225 E 21ST STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-6087
Practice Address - Country:US
Practice Address - Phone:970-714-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health