Provider Demographics
NPI:1164951158
Name:ROSARIO, J'VOHNNE M
Entity Type:Individual
Prefix:MS
First Name:J'VOHNNE
Middle Name:M
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FOREST BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1750
Mailing Address - Country:US
Mailing Address - Phone:773-663-7108
Mailing Address - Fax:
Practice Address - Street 1:255 FOREST BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1750
Practice Address - Country:US
Practice Address - Phone:773-663-7108
Practice Address - Fax:773-663-7108
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170003652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103034Medicaid