Healthcare Provider Details

I. General information

NPI: 1134183734
Provider Name (Legal Business Name): CAROL ANN ROUSSEAU M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE SUITE 400
ROCHESTER NY
14620-3042
US

IV. Provider business mailing address

127 ELMWOOD TER
ROCHESTER NY
14620-3703
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0680
  • Fax: 585-442-4114
Mailing address:
  • Phone: 585-271-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000019536
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001998-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: