MEDICARE: FARRAH G ROUSSEAU M.S., 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	SA8829	FL

General Provider Information

NPI Number	:	1548380116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH G ROUSSEAU M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5905 BENT PINE DR
Second Line	:	APT 108
City	:	ORLANDO
State	:	FL
Zip	:	32822-3306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5905 BENT PINE DR
Second Line	:	APT 108
City	:	ORLANDO
State	:	FL
Zip	:	32822-3306
Country	:	US
Telephone Number	:	407-582-9857
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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Directions to “ FARRAH G ROUSSEAU M.S., CCC-SLP” Practice Location

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