MEDICARE: ROSEMARIE NOVEMBER M.A., 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	SA618	FL
2	235Z00000X	Speech-Language Pathologist	SP 3807	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP3807	OTHER	OH	OHIO LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942316070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIE NOVEMBER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	441 SE VERADA AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-2242
Country	:	US
Telephone Number	:	772-342-1435
Fax Number	:	855-437-5783

Provider Business Practice Location Address
First Line	:	1948 SE PORT ST LUCIE BLVD
Second Line	:	SUITE B
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5510
Country	:	US
Telephone Number	:	772-342-1435
Fax Number	:	855-437-5783

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	01/11/2016

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Directions to “ ROSEMARIE NOVEMBER M.A., CCC-SLP” Practice Location

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