Provider Demographics
NPI:1639407364
Name:VERMEULEN, ROSALYN ANN (SLP-L)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:ANN
Last Name:VERMEULEN
Suffix:
Gender:F
Credentials:SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:14337 HUNTER DRIVE
Mailing Address - City:BURSON
Mailing Address - State:CA
Mailing Address - Zip Code:95225-0261
Mailing Address - Country:US
Mailing Address - Phone:209-772-2112
Mailing Address - Fax:209-772-2112
Practice Address - Street 1:14337 HUNTER DRIVE
Practice Address - Street 2:
Practice Address - City:BURSON
Practice Address - State:CA
Practice Address - Zip Code:95225-0261
Practice Address - Country:US
Practice Address - Phone:209-772-2112
Practice Address - Fax:209-772-2112
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist