MEDICARE: DR. ASHLEY ROSAEN 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	103T00000X	Psychologist	6301016069	MI

General Provider Information

NPI Number	:	1942682182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY ROSAEN PSY.D.

Provider Business Mailing Address
First Line	:	1777 AXTELL DR STE 100
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-4400
Country	:	US
Telephone Number	:	248-613-5377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 UNION LAKE RD STE 219
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3526
Country	:	US
Telephone Number	:	734-306-5143
Fax Number	:

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

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	06/24/2015

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