Provider Demographics
NPI:1437295870
Name:ROSE, JOHN S (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:ROSE
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268B TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1710
Mailing Address - Country:US
Mailing Address - Phone:850-893-8743
Mailing Address - Fax:850-893-8490
Practice Address - Street 1:1268B TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1710
Practice Address - Country:US
Practice Address - Phone:850-893-8743
Practice Address - Fax:850-893-8490
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist