Provider Demographics
NPI:1407206345
Name:ROSENBLOOM, SHARON LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3732 N WAYNE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-7160
Mailing Address - Country:US
Mailing Address - Phone:847-404-7858
Mailing Address - Fax:224-655-2213
Practice Address - Street 1:3732 N WAYNE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-7160
Practice Address - Country:US
Practice Address - Phone:847-404-7858
Practice Address - Fax:224-655-2213
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL146010081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist