MEDICARE: KRISTI ROSER

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	146.014614	IL

General Provider Information

NPI Number	:	1922562958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI ROSER

Provider Business Mailing Address
First Line	:	950 LEE ST STE 210
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-6574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 LAKE COOK RD STE 314
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4933
Country	:	US
Telephone Number	:	866-815-6592
Fax Number	:

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

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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Directions to “ KRISTI ROSER ” Practice Location

Language	Start Address	Practice Location

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