MEDICARE: HEATHER KEENA ROSE

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	6851121247	MI

General Provider Information

NPI Number	:	1326992033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER KEENA ROSE

Provider Business Mailing Address
First Line	:	5762 US HIGHWAY 31 N
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9312
Country	:	US
Telephone Number	:	734-740-0426
Fax Number	:

Provider Business Practice Location Address
First Line	:	5762 US HIGHWAY 31 N
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9312
Country	:	US
Telephone Number	:	734-740-0426
Fax Number	:

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

Provider Enumeration Date	:	02/21/2026
Last Update Date	:	02/21/2026

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Directions to “ HEATHER KEENA ROSE ” Practice Location

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