Healthcare Provider Details

I. General information

NPI: 1154675965
Provider Name (Legal Business Name): GENA MARIE ROSSOW MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 APOLLO ST
SILVER LAKE KS
66539-9611
US

IV. Provider business mailing address

424 APOLLO ST
SILVER LAKE KS
66539-9611
US

V. Phone/Fax

Practice location:
  • Phone: 913-575-3697
  • Fax:
Mailing address:
  • Phone: 913-575-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2753
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: