Provider Demographics
NPI:1548380116
Name:ROUSSEAU, FARRAH G (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:G
Last Name:ROUSSEAU
Suffix:
Gender:F
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 1:5905 BENT PINE DR
Mailing Address - Street 2:APT 108
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5905 BENT PINE DR
Practice Address - Street 2:APT 108
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-3306
Practice Address - Country:US
Practice Address - Phone:407-582-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist