Provider Demographics
NPI:1780890475
Name:POE, ROSANNE KATHERINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:KATHERINE
Last Name:POE
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 1:6214 WASHINGTON AVE
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:262-763-7249
Mailing Address - Fax:262-763-7249
Practice Address - Street 1:6214 WASHINGTON AVE
Practice Address - Street 2:SUITE C-6
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:262-763-7249
Practice Address - Fax:262-763-7249
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1490103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent