MEDICARE: KRISTIN LYNNE ROSALES LMSW

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	1041C0700X	Clinical Social Worker	6801089361	MI

General Provider Information

NPI Number	:	1952642282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LYNNE ROSALES LMSW

Provider Business Mailing Address
First Line	:	1903 WILKINS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2112
Country	:	US
Telephone Number	:	313-833-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 WILKINS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2112
Country	:	US
Telephone Number	:	313-833-1100
Fax Number	:

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

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	07/27/2022

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