Healthcare Provider Details

I. General information

NPI: 1366899304
Provider Name (Legal Business Name): ROSEMARIE ALETHA SHEGGEBY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FIRST STREET SW
ROCHESTER MN
55905
US

IV. Provider business mailing address

200 FIRST STREET SW
ROCHESTER MN
55905
US

V. Phone/Fax

Practice location:
  • Phone: 507-293-4394
  • Fax: 507-293-2304
Mailing address:
  • Phone: 507-293-4394
  • Fax: 507-293-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17784
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: