Healthcare Provider Details

I. General information

NPI: 1871408252
Provider Name (Legal Business Name): ROSA BURDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10919 MAIN ST
MANTUA OH
44255-8923
US

IV. Provider business mailing address

10919 MAIN ST
MANTUA OH
44255-8923
US

V. Phone/Fax

Practice location:
  • Phone: 330-295-8205
  • Fax:
Mailing address:
  • Phone: 330-295-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.17064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: