MEDICARE: MS. NAOMI M ROSE 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	2005018604	MO

General Provider Information

NPI Number	:	1821129164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NAOMI M ROSE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	308 S SUNRISE DR
Second Line	:
City	:	RAYMORE
State	:	MO
Zip	:	64083-9291
Country	:	US
Telephone Number	:	816-348-1514
Fax Number	:	816-348-1565

Provider Business Practice Location Address
First Line	:	614 MILL ST
Second Line	:
City	:	BELTON
State	:	MO
Zip	:	64012-3403
Country	:	US
Telephone Number	:	816-348-1514
Fax Number	:	816-348-1565

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

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

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