Individual
MICHAEL DEAN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED
Contact information
Practice address
320 6TH ST, RAYMOND, WA 98577-2503
(360) 915-6868
Mailing address
1127 WARD ST, CENTRALIA, WA 98531-5047
(360) 388-6452
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BA61483912
WA
Other
Enumeration date
06/30/2015
Last updated
04/01/2024
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