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General NPI Number Information
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NPI Number | 1114101839
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Entity Type | Individual
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Provider Name | STACY ERIN ROSE PLMHP
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Gender | Female
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 100 WEST 29TH ST SUITE 319
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City | SOUTH SIOUX
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State | NE
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Zip | 68776
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Country | US
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Telephone | 402-494-4904
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Fax | 402-494-1210
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Provider Business Mailing Address
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Address Line | 7829 CHICAGO PLZ
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City | OMAHA
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State | NE
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Zip | 68114-3653
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Country | US
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Telephone | 402-393-0163
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Fax | 402-393-7187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 8481
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License Number State | NE
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