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General NPI Number Information
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NPI Number | 1467427765
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Entity Type | Individual
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Provider Name | DAVID L ROSEEN PHD, LP
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1407 W 4TH ST
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City | RED WING
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State | MN
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Zip | 55066-2108
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Country | US
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Telephone | 651-267-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 10656 WATER LILY LN
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City | WOODBURY
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State | MN
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Zip | 55129-5228
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Country | US
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Telephone |
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP2739
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License Number State | MN
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