Provider Demographics
NPI:1962019893
Name:ROSENBERG, MIRIAM BETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:BETH
Last Name:ROSENBERG
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 1:3843 SWEET MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5949
Mailing Address - Country:US
Mailing Address - Phone:954-501-9249
Mailing Address - Fax:
Practice Address - Street 1:3843 SWEET MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5949
Practice Address - Country:US
Practice Address - Phone:954-501-9249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist