Provider Demographics
NPI:1437340247
Name:ROTTER, MAGGIE (CCC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:ROTTER
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21051 GRESHAM ST
Mailing Address - Street 2:APT. 301
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-1747
Mailing Address - Country:US
Mailing Address - Phone:818-515-8622
Mailing Address - Fax:
Practice Address - Street 1:7836 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1902
Practice Address - Country:US
Practice Address - Phone:818-881-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP1780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP1780OtherSTATE OF CALIFORNIA