=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225937493
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY ROSE REA MA. PSYCH SP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31201 DORCHESTER AVE
-----------------------------------------------------
City | MADISON HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48071-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-547-5292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31201 DORCHESTER AVE
-----------------------------------------------------
City | MADISON HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48071-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-547-5292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | CC7C0230373580
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------