Healthcare Provider Details

I. General information

NPI: 1285852103
Provider Name (Legal Business Name): JEAN COFSKY ROTHSTEIN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BRENTWOOD RD
HAVERTOWN PA
19083-5520
US

IV. Provider business mailing address

220 BRENTWOOD RD
HAVERTOWN PA
19083-5520
US

V. Phone/Fax

Practice location:
  • Phone: 610-446-7755
  • Fax:
Mailing address:
  • Phone: 610-446-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL000321L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: