Provider Demographics
NPI:1720209323
Name:ROHDE, KRISTEN JENNIFER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JENNIFER
Last Name:ROHDE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 LOBELIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004
Mailing Address - Country:US
Mailing Address - Phone:805-647-0177
Mailing Address - Fax:
Practice Address - Street 1:4562 WESTINGHOUSE ST STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5797
Practice Address - Country:US
Practice Address - Phone:805-644-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist