Healthcare Provider Details

I. General information

NPI: 1154053189
Provider Name (Legal Business Name): KARISSA K ROSENQUIST MSW,CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W HARVARD AVE
ROSEBURG OR
97471-2836
US

IV. Provider business mailing address

1221 W HARVARD AVE
ROSEBURG OR
97471-2836
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-8346
  • Fax:
Mailing address:
  • Phone: 541-357-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA18838
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: