MEDICARE: JENNIFER ROSENTHAL MS, CCC-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	2548	NE

General Provider Information

NPI Number	:	1578177911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSENTHAL MS, CCC-SLP

Provider Business Mailing Address
First Line	:	10463 S 97TH CT APT 4202
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-4584
Country	:	US
Telephone Number	:	712-308-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	15505 RUGGLES ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-8832
Country	:	US
Telephone Number	:	531-466-3121
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	10/01/2021

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Directions to “ JENNIFER ROSENTHAL MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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