Provider Demographics
NPI:1578175345
Name:ROTTER, ROSE ANGELA (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANGELA
Last Name:ROTTER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2776 JANITELL RD
Mailing Address - Street 2:
Mailing Address - City:COLO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4103
Mailing Address - Country:US
Mailing Address - Phone:719-332-4689
Mailing Address - Fax:
Practice Address - Street 1:2776 JANITELL RD
Practice Address - Street 2:
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4103
Practice Address - Country:US
Practice Address - Phone:719-332-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist