Provider Demographics
NPI:1740479591
Name:ROSE, DEBORAH ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 CHEVY CHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2274
Mailing Address - Country:US
Mailing Address - Phone:269-342-2342
Mailing Address - Fax:
Practice Address - Street 1:217 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1320
Practice Address - Country:US
Practice Address - Phone:269-673-1896
Practice Address - Fax:269-686-2011
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008786103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling