Provider Demographics
NPI:1821278102
Name:ROSAS, BRENDA LOUISE (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:ROSAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 MERIAL PASS
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409
Mailing Address - Country:US
Mailing Address - Phone:850-630-9143
Mailing Address - Fax:
Practice Address - Street 1:12801 MERIAL PASS
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32409
Practice Address - Country:US
Practice Address - Phone:850-630-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2817235Z00000X
FLSA 11823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist