Provider Demographics
NPI:1316717804
Name:OVERTON, ROSEMARENA MAE
Entity type:Individual
Prefix:
First Name:ROSEMARENA
Middle Name:MAE
Last Name:OVERTON
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 1:22022 127TH ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7639
Mailing Address - Country:US
Mailing Address - Phone:253-632-8093
Mailing Address - Fax:
Practice Address - Street 1:22022 127TH ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7639
Practice Address - Country:US
Practice Address - Phone:253-632-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst