MEDICARE: DR. MARY KRIPNER ROSEN

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	103TS0200X	School Psychologist	1912530	IL

General Provider Information

NPI Number	:	1417467432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY KRIPNER ROSEN

Provider Business Mailing Address
First Line	:	900 S GROVE AVE
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5023
Country	:	US
Telephone Number	:	847-381-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 S GROVE AVE
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5023
Country	:	US
Telephone Number	:	847-381-1888
Fax Number	:

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

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	10/04/2017

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