Healthcare Provider Details

I. General information

NPI: 1497317523
Provider Name (Legal Business Name): ADELE PERRY ROSENAUER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N 500 E
LOGAN UT
84341-2455
US

IV. Provider business mailing address

1480 N 1750 E
LOGAN UT
84341-2987
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-6440
  • Fax:
Mailing address:
  • Phone: 435-760-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10823775-4104
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: