Individual
MR. RUSSELL J ROSENQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4205 N 100TH ST, OMAHA, NE 68134-3724
(402) 619-1079
Mailing address
4205 N 100TH ST, OMAHA, NE 68134-3724
(402) 619-1079
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
#675
NE
1041C0700X
Clinical Social Worker
#653
NE
1041C0700X
Clinical Social Worker
675
NE
Other
Enumeration date
02/18/2009
Last updated
02/22/2021
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