MEDICARE: BRENDA LOUISE ROSAS M.S., CCC-SLP/L

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	2817	OK
2	235Z00000X	Speech-Language Pathologist	SA 11823	FL

General Provider Information

NPI Number	:	1821278102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LOUISE ROSAS M.S., CCC-SLP/L

Provider Business Mailing Address
First Line	:	12801 MERIAL PASS
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409
Country	:	US
Telephone Number	:	850-630-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	12801 MERIAL PASS
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409
Country	:	US
Telephone Number	:	850-630-9143
Fax Number	:

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	10/02/2012

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