Provider Demographics
NPI:1124307731
Name:ROSE, UYEN-TRANG N (LCPC)
Entity type:Individual
Prefix:
First Name:UYEN-TRANG
Middle Name:N
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24208 CHAMPION DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-1297
Mailing Address - Country:US
Mailing Address - Phone:630-362-1163
Mailing Address - Fax:
Practice Address - Street 1:1979 N MILL ST STE 202
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8472
Practice Address - Country:US
Practice Address - Phone:630-362-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional