Provider Demographics
NPI:1629296843
Name:ROSTEN, SARAH REBECCA (MA CCCL)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:ROSTEN
Suffix:
Gender:F
Credentials:MA CCCL
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:REBECCA
Other - Last Name:KOZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 COMMERCE DR
Mailing Address - Street 2:STE 116
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030
Mailing Address - Country:US
Mailing Address - Phone:847-223-7433
Mailing Address - Fax:847-665-1107
Practice Address - Street 1:15 COMMERCE DR
Practice Address - Street 2:STE 116
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030
Practice Address - Country:US
Practice Address - Phone:847-223-7433
Practice Address - Fax:847-665-1107
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006016235Z00000X, 222Q00000X
IL146006016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist