Provider Demographics
NPI:1114504446
Name:VARGO, ROSE (MA SLP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:VARGO
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 NAN LINN DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4364
Mailing Address - Country:US
Mailing Address - Phone:440-954-2825
Mailing Address - Fax:
Practice Address - Street 1:5376 NAN LINN DR
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4364
Practice Address - Country:US
Practice Address - Phone:440-954-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist