Healthcare Provider Details

I. General information

NPI: 1205730249
Provider Name (Legal Business Name): CORINNE G ROSE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 35TH ST
MARION IN
46953-3442
US

IV. Provider business mailing address

508 E SOUTH F ST
GAS CITY IN
46933-1936
US

V. Phone/Fax

Practice location:
  • Phone: 765-573-5055
  • Fax:
Mailing address:
  • Phone: 765-573-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33012308A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: