MEDICARE: BERENICE ROSALES 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	118251	TX

General Provider Information

NPI Number	:	1568105229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERENICE ROSALES MS, CCC-SLP

Provider Business Mailing Address
First Line	:	595 W SESAME DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-7962
Country	:	US
Telephone Number	:	956-428-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 N CLOSNER BLVD STE A
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78541-7292
Country	:	US
Telephone Number	:	956-997-3997
Fax Number	:

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

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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