Doctor Name: | KIM DE LA ROSA |
NPI Number: | 1699130187 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCCSLP |
License Number: | 8045629 |
Business Practice Address: | 1248 Hospital Dr St Johnsbury, VT - 058199239 |
Business Phone Number: | 8027488757 |
Business Fax Number: | |
Mailing Address: | 183 Tremont St, ST JOHNSBURY |
State: | VT |
Postal Code: | 058191154 |
Phone Number: | 8022741734 |
Fax Number: | |
NPI Enumeration Date: | 12/28/2015 |
NPI Last Update Date: | 12/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 8045629 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |