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NPI Code Detail

MEDICARE: ERIC ROSE MA

MEDICARE: ERIC ROSE MA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1922428564
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC ROSE MA
Provider Business Mailing Address
First Line : 905 SE 14TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2569
Country : US
Telephone Number : 503-622-8964
Fax Number : 503-715-5469
Provider Business Practice Location Address
First Line : 905 SE 14TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2569
Country : US
Telephone Number : 503-622-8964
Fax Number : 503-715-5469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2014
Last Update Date : 11/06/2023

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Directions to “ ERIC ROSE MA” Practice Location

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