Provider Demographics
NPI:1376970475
Name:ROSE, KAREN M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1327
Mailing Address - Country:US
Mailing Address - Phone:845-429-0942
Mailing Address - Fax:
Practice Address - Street 1:65 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1238
Practice Address - Country:US
Practice Address - Phone:845-942-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004609-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist