Provider Demographics
NPI:1720211907
Name:ROSEN, ELLA Z (SLP)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:Z
Last Name:ROSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2028
Mailing Address - Country:US
Mailing Address - Phone:205-348-7131
Mailing Address - Fax:205-348-7216
Practice Address - Street 1:700 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2028
Practice Address - Country:US
Practice Address - Phone:205-348-7131
Practice Address - Fax:205-348-7216
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist