Provider Demographics
NPI:1780053546
Name:ROSENGREN, JONATHAN (MSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ROSENGREN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W FERRY ST
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1109
Mailing Address - Country:US
Mailing Address - Phone:269-815-5331
Mailing Address - Fax:
Practice Address - Street 1:415 E MADISON STREET
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1109
Practice Address - Country:US
Practice Address - Phone:269-815-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010987801041C0700X
IN33008049A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical