MEDICARE: DR. JONATHAN ROSARIO PSY.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	5498-57	WI
2	103T00000X	Psychologist	5498-57	WI
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740141340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN ROSARIO PSY.D.

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 PRAIRIE DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-3973
Country	:	US
Telephone Number	:	262-999-2792
Fax Number	:

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

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	03/10/2026

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