Provider Demographics
NPI:1457240053
Name:ELLINGER, ROSE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ELLINGER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:GOLDFARB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:648 HUDSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:ME
Mailing Address - Zip Code:04449-3502
Mailing Address - Country:US
Mailing Address - Phone:631-312-3747
Mailing Address - Fax:
Practice Address - Street 1:175 FERN RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-2725
Practice Address - Country:US
Practice Address - Phone:207-924-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP4313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist