Healthcare Provider Details

I. General information

NPI: 1548178825
Provider Name (Legal Business Name): KIMBERLY ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 W CHICAGO BLVD STE A
TECUMSEH MI
49286-8727
US

IV. Provider business mailing address

241 SOUTHFIELD DR STE 2
ADRIAN MI
49221-4287
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-5555
  • Fax:
Mailing address:
  • Phone: 517-366-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: