Healthcare Provider Details

I. General information

NPI: 1174447460
Provider Name (Legal Business Name): JAYLA ROSTORFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 BEECHMONT AVE
CINCINNATI OH
45230-2993
US

IV. Provider business mailing address

13606 LANDECK RD
DELPHOS OH
45833-9417
US

V. Phone/Fax

Practice location:
  • Phone: 513-650-7007
  • Fax:
Mailing address:
  • Phone: 419-604-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20263608
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: