=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790374544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ROSADO LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2021
-----------------------------------------------------
Last Update Date | 10/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 SOUTHBRIDGE PKWY STE 650
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-1317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-578-6755
-----------------------------------------------------
Fax | 205-941-8036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 SW 80TH ST
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73505-6442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-695-6964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 04700
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------