Provider Demographics
NPI:1215389143
Name:ROSEN, NICOLE M (MA, SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:ROSEN
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 1:74 ARLYN DR E
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6107
Mailing Address - Country:US
Mailing Address - Phone:516-644-7425
Mailing Address - Fax:
Practice Address - Street 1:5 MERLE LN
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1945
Practice Address - Country:US
Practice Address - Phone:516-644-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist