Healthcare Provider Details

I. General information

NPI: 1346641214
Provider Name (Legal Business Name): ROUCHELLE DEUX MSED, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LINDEN AVE
MOUNT VERNON NY
10552-3107
US

IV. Provider business mailing address

30 LINDEN AVE
MOUNT VERNON NY
10552-3107
US

V. Phone/Fax

Practice location:
  • Phone: 646-748-2302
  • Fax:
Mailing address:
  • Phone: 646-748-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number034254
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number834709141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: