Individual
MARY H ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1700 E 38TH ST, MARION, IN 46953-4568
(765) 674-3321
Mailing address
1732 S HADLEY RD, FORT WAYNE, IN 46804-1458
(260) 438-4905
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004314A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324983
ANTHEM
IN
05
—
200002660
—
IN
Enumeration date
12/12/2006
Last updated
05/05/2024
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