MEDICARE: ROSE SPEECH & ACADEMIC CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA1187	FL

General Provider Information

NPI Number	:	1003869579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE SPEECH & ACADEMIC CENTER, LLC

Provider Business Mailing Address
First Line	:	1268B TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1710
Country	:	US
Telephone Number	:	850-893-8743
Fax Number	:	850-893-8490

Provider Business Practice Location Address
First Line	:	1268B TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1710
Country	:	US
Telephone Number	:	850-893-8743
Fax Number	:	850-893-8490

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN STEVEN ROSE
Credential	:	SLP
Telephone Number	:	850-893-8743

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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