MEDICARE: DR. PATRICIA RIDDLE ROSE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	23477	TX

General Provider Information

NPI Number	:	1023027000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA RIDDLE ROSE PH.D.

Provider Business Mailing Address
First Line	:	5944 LUTHER LN
Second Line	:	SUITE 650
City	:	DALLAS
State	:	TX
Zip	:	75225-5942
Country	:	US
Telephone Number	:	214-373-4467
Fax Number	:	214-373-6360

Provider Business Practice Location Address
First Line	:	5944 LUTHER LN
Second Line	:	SUITE 650
City	:	DALLAS
State	:	TX
Zip	:	75225-5942
Country	:	US
Telephone Number	:	214-373-4467
Fax Number	:	214-373-6360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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