Provider Demographics
NPI:1417076704
Name:ROZELL, AUDREY M
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:ROZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FIFTH AVE
Mailing Address - Street 2:SPEECH PATHOLOGY 1 MANSFIELD
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2313
Mailing Address - Country:US
Mailing Address - Phone:412-664-2479
Mailing Address - Fax:
Practice Address - Street 1:283 GROUSE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2313
Practice Address - Country:US
Practice Address - Phone:412-664-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005956L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist