Provider Demographics
NPI:1619114204
Name:ROSADO-WOOLFE, REBECCA ELISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELISA
Last Name:ROSADO-WOOLFE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 33461
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-3461
Mailing Address - Country:US
Mailing Address - Phone:561-254-9277
Mailing Address - Fax:615-704-3033
Practice Address - Street 1:710 DUCHESS CT
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1554
Practice Address - Country:US
Practice Address - Phone:561-254-9277
Practice Address - Fax:615-704-3033
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSA 9720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12130977OtherAMERICA SPEECH-LANGUAGE HEARING ASSOCIATION CERTIFICATE OF CLINICAL COMPETENCE
FLSA 9720OtherBOARD OF SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY