Healthcare Provider Details

I. General information

NPI: 1528995339
Provider Name (Legal Business Name): JEANNI ROCHELLE ROSELLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MONTEREY RD
GLENDALE CA
91206-2521
US

IV. Provider business mailing address

1791 LYDIA CIR
SIMI VALLEY CA
93065-3512
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-8145
  • Fax:
Mailing address:
  • Phone: 818-244-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: