Healthcare Provider Details

I. General information

NPI: 1790374544
Provider Name (Legal Business Name): JENNIFER ROSADO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 W GORE BLVD STE 2
LAWTON OK
73505-5978
US

IV. Provider business mailing address

4417 W GORE BLVD STE 2
LAWTON OK
73505-5978
US

V. Phone/Fax

Practice location:
  • Phone: 580-695-6964
  • Fax: 205-941-8036
Mailing address:
  • Phone: 580-695-6964
  • Fax: 205-941-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11494
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: