Provider Demographics
NPI:1821322744
Name:ROSENWASSER, SALLY (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ROSENWASSER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 BURN BRAE DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1612
Mailing Address - Country:US
Mailing Address - Phone:215-783-5533
Mailing Address - Fax:
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:215-731-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003967L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist