Provider Demographics
NPI:1821580028
Name:ROUSE, RIXON (AUD)
Entity Type:Individual
Prefix:
First Name:RIXON
Middle Name:
Last Name:ROUSE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 EUCLID AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2649
Mailing Address - Country:US
Mailing Address - Phone:512-797-8956
Mailing Address - Fax:
Practice Address - Street 1:4141 GEARY BLVD FL 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3118
Practice Address - Country:US
Practice Address - Phone:415-833-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE11685231H00000X
CAAU3311231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist