Provider Demographics
NPI:1942316070
Name:NOVEMBER, ROSEMARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:NOVEMBER
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 1:441 SE VERADA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2242
Mailing Address - Country:US
Mailing Address - Phone:772-342-1435
Mailing Address - Fax:855-437-5783
Practice Address - Street 1:1948 SE PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5510
Practice Address - Country:US
Practice Address - Phone:772-342-1435
Practice Address - Fax:855-437-5783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA618235Z00000X
OHSP 3807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP3807OtherOHIO LICENSE NUMBER
FL885836500Medicaid