Provider Demographics
NPI:1568618338
Name:ROSEN, PHYLLIS F (MA)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:F
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HEATHER DR
Mailing Address - Street 2:APT 2
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1711
Mailing Address - Country:US
Mailing Address - Phone:937-275-3291
Mailing Address - Fax:
Practice Address - Street 1:540 HEATHER DR
Practice Address - Street 2:APT 2
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1711
Practice Address - Country:US
Practice Address - Phone:937-275-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00216231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist