Individual
DR. JONATHAN DALE ROSENBOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
17571 N DAM ACCESS RD, WARSAW, MO 65355
(888) 403-1071
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01221
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076557
MISSOURI OFFICE OF ADMINISTRATION
MO
Enumeration date
04/17/2009
Last updated
03/18/2020
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