Provider Demographics
NPI:1215178884
Name:TUCKER, ROSANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSANN
Middle Name:
Last Name:TUCKER
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 1:1212 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2823
Mailing Address - Country:US
Mailing Address - Phone:810-982-0204
Mailing Address - Fax:
Practice Address - Street 1:1212 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2823
Practice Address - Country:US
Practice Address - Phone:810-982-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist