Provider Demographics
NPI:1336629500
Name:ROSSELOT, MEGAN SU
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SU
Last Name:ROSSELOT
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 1:23215 COMMERCE PARK STE 306
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5843
Mailing Address - Country:US
Mailing Address - Phone:216-244-7350
Mailing Address - Fax:
Practice Address - Street 1:23215 COMMERCE PARK STE 306
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5843
Practice Address - Country:US
Practice Address - Phone:216-532-3427
Practice Address - Fax:216-502-2803
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator