Healthcare Provider Details

I. General information

NPI: 1790065597
Provider Name (Legal Business Name): ROBYN N ROSEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BELL RD
WRIGHT CITY MO
63390-3202
US

IV. Provider business mailing address

90 BELL RD
WRIGHT CITY MO
63390-3202
US

V. Phone/Fax

Practice location:
  • Phone: 636-745-7200
  • Fax: 636-745-3613
Mailing address:
  • Phone: 636-745-7200
  • Fax: 636-745-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2011017278
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: