Provider Demographics
NPI:1487931994
Name:ROSENBURGH, KATIE N (LMSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:N
Last Name:ROSENBURGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 AVENUE O W
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5634
Mailing Address - Country:US
Mailing Address - Phone:515-573-2193
Mailing Address - Fax:
Practice Address - Street 1:1111 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2329
Practice Address - Country:US
Practice Address - Phone:515-288-1981
Practice Address - Fax:515-288-9106
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0075671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical