Provider Information for 1477261493
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ROSEANNE SMALL KING LCSW
Sex: Female
NPI: 1477261493
Last Updated: 2022-11-08
Certification Date: 2022-11-08
Certification Date: 2022-11-08
Details
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NPI | 1477261493 | ||||||||
Enumeration Date | 2022-11-08 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 109 FAIRWAY LN WHEATON, IL 60189-6431 United States Phone: 630-346-1379 | Fax: | ||||||||
Primary Practice Address | 109 FAIRWAY LN WHEATON, IL 60189-6431 United States Phone: 630-346-1379 | Fax: | ||||||||
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