Provider Demographics
NPI:1154675965
Name:ROSSOW, GENA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:MARIE
Last Name:ROSSOW
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 APOLLO ST
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9611
Mailing Address - Country:US
Mailing Address - Phone:913-575-3697
Mailing Address - Fax:
Practice Address - Street 1:424 APOLLO ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:KS
Practice Address - Zip Code:66539-9611
Practice Address - Country:US
Practice Address - Phone:913-575-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist