Provider Demographics
NPI:1073407888
Name:ROSANELLI, KRISTEN MICHELE (MA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELE
Last Name:ROSANELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 HISTORICAL AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-0020
Mailing Address - Country:US
Mailing Address - Phone:405-837-8098
Mailing Address - Fax:
Practice Address - Street 1:1600 E 19TH ST STE 404
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6624
Practice Address - Country:US
Practice Address - Phone:405-509-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health