Provider Demographics
NPI:1952838799
Name:PHILLIPPI, ROSANNA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:MARIE
Last Name:PHILLIPPI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:ROSANNA
Other - Middle Name:MARIE
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:3060 QUASAR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4788
Mailing Address - Country:US
Mailing Address - Phone:970-769-2162
Mailing Address - Fax:
Practice Address - Street 1:281 SAWYER DR
Practice Address - Street 2:SUITE # 200
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3409
Practice Address - Country:US
Practice Address - Phone:970-259-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist