MEDICARE: MRS. JENNIFER L ROSENTHAL-DIBB MS CCC-SLP

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	3200	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1156E	OTHER	NC	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1225019094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L ROSENTHAL-DIBB MS CCC-SLP

Provider Business Mailing Address
First Line	:	4602 CUMBERLAND RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2412
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-378-1755

Provider Business Practice Location Address
First Line	:	4602 CUMBERLAND RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2412
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-423-5538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/15/2021

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Directions to “ MRS. JENNIFER L ROSENTHAL-DIBB MS CCC-SLP” Practice Location

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