Provider Demographics
NPI:1346072865
Name:ROSENDAHL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROSENDAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LAURA
Other - Last Name:ROSENDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2336 SE OCEAN BLVD # 169
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3310
Mailing Address - Country:US
Mailing Address - Phone:772-834-4867
Mailing Address - Fax:
Practice Address - Street 1:2336 SE OCEAN BLVD # 169
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3310
Practice Address - Country:US
Practice Address - Phone:772-834-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst