Healthcare Provider Details

I. General information

NPI: 1912923426
Provider Name (Legal Business Name): MIA ALEXANDRA LEE ROSENFELD PH.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S AUDIOLOGY AND SPEECH PATHOLOGY (126)
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

2201 WESTVIEW DR
NASHVILLE TN
37212-4123
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4751
  • Fax: 615-321-6369
Mailing address:
  • Phone: 615-298-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0345
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: