MEDICARE: MS. ROSANNE JUSTIAN LIC MAST OF SOC WORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801068418	MI

General Provider Information

NPI Number	:	1447369335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSANNE JUSTIAN LIC MAST OF SOC WORK

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

Provider Business Practice Location Address
First Line	:	14998 CLEVELAND ST STE K
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-8993
Country	:	US
Telephone Number	:	616-422-2344
Fax Number	:	616-453-6157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/28/2011

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