Healthcare Provider Details

I. General information

NPI: 1497231146
Provider Name (Legal Business Name): ROSIN THURUTHICKARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD
ANKENY IA
50023-9417
US

IV. Provider business mailing address

2300 LINCOLN WAY UNIT 606
AMES IA
50014-7173
US

V. Phone/Fax

Practice location:
  • Phone: 515-598-7200
  • Fax:
Mailing address:
  • Phone: 408-731-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-01316
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: