Individual
MS. ROXANNE MAE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
217 GRANDVIEW AVE, DEVILS LAKE, ND 58301-4123
(701) 662-5590
(701) 665-3252
Mailing address
217 GRANDVIEW AVE, DEVILS LAKE, ND 58301-4123
(701) 662-5590
(701) 665-3252
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2096
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181620900
—
MN
05
—
19124
—
ND
01
—
23117
BC/BC
ND
01
—
24043
ND BC/BS
ND
01
—
284K8DA
MN BC/BS
MN
01
—
N715569
MEDICARE PTAN
ND
Enumeration date
04/21/2006
Last updated
02/02/2012
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