MEDICARE: CORINNA ROSENDAHL

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	104100000X	Social Worker	SW140104	PA

General Provider Information

NPI Number	:	1306608310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNA ROSENDAHL

Provider Business Mailing Address
First Line	:	4630 HAZEL AVE APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2180
Country	:	US
Telephone Number	:	509-301-8838
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 HAZEL AVE APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2180
Country	:	US
Telephone Number	:	509-301-8838
Fax Number	:

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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Directions to “ CORINNA ROSENDAHL ” Practice Location

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