Provider Demographics
NPI:1225389034
Name:ROSEDALE, MAREA ANNE (MS)
Entity Type:Individual
Prefix:
First Name:MAREA
Middle Name:ANNE
Last Name:ROSEDALE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 KANE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1418
Mailing Address - Country:US
Mailing Address - Phone:630-824-7765
Mailing Address - Fax:
Practice Address - Street 1:759 KANE ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1418
Practice Address - Country:US
Practice Address - Phone:740-632-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist