Provider Demographics
NPI:1497754196
Name:GODFREY, ROSEMARY MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:MARIE
Last Name:GODFREY
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 1:395 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4121
Mailing Address - Country:US
Mailing Address - Phone:530-673-7777
Mailing Address - Fax:530-673-0132
Practice Address - Street 1:395 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4121
Practice Address - Country:US
Practice Address - Phone:530-673-7777
Practice Address - Fax:530-673-0132
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056581Medicare Oscar/Certification