Provider Demographics
NPI:1053597583
Name:ROSMAN-BANGASSER, KAREN LEE (CPRP MS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:ROSMAN-BANGASSER
Suffix:
Gender:F
Credentials:CPRP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1865
Mailing Address - Country:US
Mailing Address - Phone:320-589-3077
Mailing Address - Fax:320-589-4955
Practice Address - Street 1:110 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPICER
Practice Address - State:MN
Practice Address - Zip Code:56288-9671
Practice Address - Country:US
Practice Address - Phone:320-796-2471
Practice Address - Fax:320-796-5625
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21102100OtherMEDICARE