Provider Demographics
NPI:1417102195
Name:MANNOZZI, ROSA ENRIQUETA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:ENRIQUETA
Last Name:MANNOZZI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 PELHAMDALE AVE
Mailing Address - Street 2:APT 48
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2809
Mailing Address - Country:US
Mailing Address - Phone:631-805-8564
Mailing Address - Fax:
Practice Address - Street 1:622 PELHAMDALE AVE
Practice Address - Street 2:APT 48
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2809
Practice Address - Country:US
Practice Address - Phone:631-805-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0177821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist