Healthcare Provider Details

I. General information

NPI: 1790695468
Provider Name (Legal Business Name): ELIZABETH ROSIEJKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 PINEHURST AVE
GREEN BAY WI
54302-4214
US

IV. Provider business mailing address

2950 SAFFRON LN
NEENAH WI
54956-9034
US

V. Phone/Fax

Practice location:
  • Phone: 920-391-2405
  • Fax:
Mailing address:
  • Phone: 920-810-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: