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NPI Code Detail

MEDICARE: JOHANNA ROSE SLP

MEDICARE: JOHANNA ROSE 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
1235Z00000XSpeech-Language Pathologist7101004407MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17101004407OTHERMISPEECH LANGUAGE PATHOLOGIST LICENSE

General Provider Information

NPI Number : 1255804191
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHANNA ROSE SLP
Provider Business Mailing Address
First Line : 52054 JOHNSON RD
Second Line :
City : THREE RIVERS
State : MI
Zip : 49093-9755
Country : US
Telephone Number : 260-433-0813
Fax Number :
Provider Business Practice Location Address
First Line : 23770 HOSPITAL ST
Second Line :
City : CASSOPOLIS
State : MI
Zip : 49031-9644
Country : US
Telephone Number : 269-445-3801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2019
Last Update Date : 01/03/2019

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Directions to “ JOHANNA ROSE SLP” Practice Location

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