Provider Demographics
NPI:1881097921
Name:ROSE, JAMIELYNN LOUISE
Entity type:Individual
Prefix:
First Name:JAMIELYNN
Middle Name:LOUISE
Last Name:ROSE
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 1:1419 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-8200
Mailing Address - Country:US
Mailing Address - Phone:775-790-1661
Mailing Address - Fax:
Practice Address - Street 1:1419 PATRICIA DR
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89460-8200
Practice Address - Country:US
Practice Address - Phone:775-790-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health