Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 07046 | IA |
NPI | 1003089939 |
---|---|
Provider Name | Mr. Larry T Rossow |
First Address | Newton, IA 50208-3249 |
Second Address | Newton, IA 50208-3249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 11/04/2008 |