Provider Demographics
NPI:1033191283
Name:DEMATTIA PASH, ROSANNE (SLP-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:
Last Name:DEMATTIA PASH
Suffix:
Gender:F
Credentials:SLP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 E 9TH AVE
Mailing Address - Street 2:ATTN ROSE INPATIENT REHAB
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3908
Mailing Address - Country:US
Mailing Address - Phone:303-320-2818
Mailing Address - Fax:303-320-7117
Practice Address - Street 1:4567 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3908
Practice Address - Country:US
Practice Address - Phone:303-320-2818
Practice Address - Fax:303-320-7117
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0108759202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63934051Medicaid
CO066615OtherMEDICARE GROUP #
CO86723251OtherMEDICAID GROUP PRACTICE #