Provider Demographics
NPI:1912932435
Name:ROSENAK, CHARLOTTE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:M
Last Name:ROSENAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8575 W 110TH ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-345-0033
Mailing Address - Fax:913-345-0177
Practice Address - Street 1:8575 W 110TH ST
Practice Address - Street 2:SUITE 218
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-345-0033
Practice Address - Fax:913-345-0177
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4957138701Medicaid
KS4957138701Medicaid