Provider Demographics
NPI:1609901917
Name:ROSEMARY AYRES, MS, CCC-SLP
Entity Type:Organization
Organization Name:ROSEMARY AYRES, MS, CCC-SLP
Other - Org Name:SPEECH CAMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:541-929-4568
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-1492
Mailing Address - Country:US
Mailing Address - Phone:541-929-4568
Mailing Address - Fax:541-929-4513
Practice Address - Street 1:138 S 12TH STR
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-1492
Practice Address - Country:US
Practice Address - Phone:541-929-4568
Practice Address - Fax:541-929-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORY6967-01OtherPACIFICSOURCE HEALTHCARE
OR138396OtherOMAP-OFFICE MEDICAL ASSIS
OR14951000OtherREGENT BLUE CROSS BLUE SH