1447369335 NPI number — MS. ROSANNE JUSTIAN LIC MAST OF SOC WORK

Table of content: MS. ROSANNE JUSTIAN LIC MAST OF SOC WORK (NPI 1447369335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447369335 NPI number — MS. ROSANNE JUSTIAN LIC MAST OF SOC WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUSTIAN
Provider First Name:
ROSANNE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LIC MAST OF SOC WORK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447369335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 DEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-343-1072
Provider Business Mailing Address Fax Number:
616-935-7045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14998 CLEVELAND ST STE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49456-8993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-422-2344
Provider Business Practice Location Address Fax Number:
616-453-6157
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801068418 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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