Ann Rousselle, PH.D

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

7893436-2501 Issued in UT

Practice address

5770 S 1500 W
Building G
Salt Lake City, UT 84123-5216

Phone

(801) 313-7770

Fax

(801) 313-7771

NPI assigned

Mar 15, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Suburban Psychiatric Associates, LLP

  • Psychiatry Physician
  • Amherst, NY
  • NPI 1851331367
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508803200000",
    "number": "1396044459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 BRYANT WOODS S",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142283604",
            "telephone_number": "801-313-7770",
            "fax_number": "801-313-7771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 S 1500 W",
            "address_2": "BUILDING G",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841235216",
            "telephone_number": "801-313-7770",
            "fax_number": "801-313-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSELLE",
        "first_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-15",
        "last_updated": "2017-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "UT",
            "license": "7893436-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy Lynn Rountree-Benedict, RD
• Mariah Rouse
• Vanessa Roush, FDNP
• Emily Ferris Rousseau, LCSW
• Danielle Roussel
• Gregory Darrell Rowan, D.P.M.
• Brooke Rowe
• Julius Rowe
• Megan B. Rowe, PA-C
• Caitlin Sarah Rower, M.D.

• Clinical Child & Adolescent Psychologist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Child & Adolescent Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.