Individual
MS. VICKI J ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS,CADC
Contact information
Practice address
2323 WINDISH DR, GALESBURG, IL 61401-9780
(309) 344-4200
(309) 344-4281
Mailing address
2323 WINDISH DR, GALESBURG, IL 61401-9780
(309) 344-2323
(309) 344-4368
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370984175
FEIN ORGANIZATION
IL
Enumeration date
03/19/2007
Last updated
09/22/2009
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