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NPI Code Detail

MEDICARE: DR. JACQUELINE ANN ROSE PHD, LPCC-SUPV

MEDICARE: DR. JACQUELINE ANN ROSE PHD, LPCC-SUPV
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
1101YP2500XProfessional CounselorE.0002439SUPVOH

General Provider Information

NPI Number : 1740339803
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE ANN ROSE PHD, LPCC-SUPV
Provider Business Mailing Address
First Line : 280 CLARK DR APT F47
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-1491
Country : US
Telephone Number : 614-595-7633
Fax Number :
Provider Business Practice Location Address
First Line : 10921 REED HARTMAN HWY STE 133
Second Line :
City : BLUE ASH
State : OH
Zip : 45242-2851
Country : US
Telephone Number : 513-984-9838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 09/13/2023

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