Provider Demographics
NPI:1720647753
Name:ROSE, ALLISON LYNN (MA, LAMFT)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:LYNN
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:LYNN
Other - Last Name:SICKINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LAMFT
Mailing Address - Street 1:5407 EXCELSIOR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2932
Mailing Address - Country:US
Mailing Address - Phone:920-901-4496
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD STE B
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2932
Practice Address - Country:US
Practice Address - Phone:920-901-4496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist