MEDICARE: SAMANTHA LISA ROSE M.S. CF-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SZ8994	FL

General Provider Information

NPI Number	:	1427518984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LISA ROSE M.S. CF-SLP

Provider Business Mailing Address
First Line	:	880 6TH ST S STE 210
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 6TH ST S STE 210
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4823
Country	:	US
Telephone Number	:	727-767-4141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/21/2019

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Directions to “ SAMANTHA LISA ROSE M.S. CF-SLP” Practice Location

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