Provider Demographics
NPI:1821129164
Name:ROSE, NAOMI M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:M
Last Name:ROSE
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 1:308 S SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9291
Mailing Address - Country:US
Mailing Address - Phone:816-348-1514
Mailing Address - Fax:816-348-1565
Practice Address - Street 1:614 MILL ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-3403
Practice Address - Country:US
Practice Address - Phone:816-348-1514
Practice Address - Fax:816-348-1565
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist