Provider Demographics
NPI:1720257611
Name:ROUSE, AMY PATRICIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:PATRICIA
Last Name:ROUSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-0093
Mailing Address - Country:US
Mailing Address - Phone:614-360-9598
Mailing Address - Fax:
Practice Address - Street 1:444 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8387
Practice Address - Country:US
Practice Address - Phone:614-360-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist