Individual
ROSE MARY HEISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CAADC, LPN
Contact information
Practice address
1500 W MICHIGAN AVE, JACKSON, MI 49202-4025
(517) 740-1351
Mailing address
1500 W MICHIGAN AVE, JACKSON, MI 49202-4025
(517) 740-1351
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1-00244
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
750910682
BCBSM
MI
Enumeration date
03/08/2007
Last updated
03/27/2015
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