Provider Demographics
NPI:1801296017
Name:ROUSH, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ROUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:OH
Mailing Address - Zip Code:45780-1333
Mailing Address - Country:US
Mailing Address - Phone:740-797-4516
Mailing Address - Fax:740-797-2486
Practice Address - Street 1:25 S PLAINS RD
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1333
Practice Address - Country:US
Practice Address - Phone:740-797-4516
Practice Address - Fax:740-797-2486
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3083705103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool