Provider Demographics
NPI:1891514949
Name:ROZEN, REID (MT-BC)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:ROZEN
Suffix:
Gender:X
Credentials:MT-BC
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:ROZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-0986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 E 5TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4757
Practice Address - Country:US
Practice Address - Phone:516-513-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI370-38225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist