Healthcare Provider Details

I. General information

NPI: 1235675802
Provider Name (Legal Business Name): JAMIE ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CINCINNATI BATAVIA PIKE
CINCINNATI OH
45244-1557
US

IV. Provider business mailing address

7058 PADDISON RD
CINCINNATI OH
45230-2343
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-910-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1502333
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: