Provider Demographics
NPI:1447369335
Name:JUSTIAN, ROSANNE (LIC MAST OF SOC WORK)
Entity type:Individual
Prefix:MS
First Name:ROSANNE
Middle Name:
Last Name:JUSTIAN
Suffix:
Gender:F
Credentials:LIC MAST OF SOC WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DEE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-343-1072
Mailing Address - Fax:616-935-7045
Practice Address - Street 1:14998 CLEVELAND ST STE K
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8993
Practice Address - Country:US
Practice Address - Phone:616-422-2344
Practice Address - Fax:616-453-6157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010684181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical