Provider Demographics
NPI:1477709749
Name:PAGE, ROSE MARIE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:MARIE
Last Name:PAGE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GALESVILLE DR
Mailing Address - Street 2:APT. B
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-2304
Mailing Address - Country:US
Mailing Address - Phone:518-312-0434
Mailing Address - Fax:
Practice Address - Street 1:35 GALESVILLE DR
Practice Address - Street 2:APT. B
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-2304
Practice Address - Country:US
Practice Address - Phone:518-312-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008800-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist