Provider Demographics
NPI:1578087649
Name:ROSENBERG, MEREDITH ANITA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:ANITA
Last Name:ROSENBERG
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 1:4 WEBB CT
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2426
Mailing Address - Country:US
Mailing Address - Phone:917-861-6461
Mailing Address - Fax:
Practice Address - Street 1:4 WEBB CT
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2426
Practice Address - Country:US
Practice Address - Phone:917-861-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1038204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty