Provider Demographics
NPI:1366223232
Name:ROSENBERG, STACY MICHELLE
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:MICHELLE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 MONTELLO PL
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1094
Mailing Address - Country:US
Mailing Address - Phone:541-399-6156
Mailing Address - Fax:
Practice Address - Street 1:2012 E 14TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3974
Practice Address - Country:US
Practice Address - Phone:541-399-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator