Provider Demographics
NPI:1972644839
Name:ROSE, SONYA F (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:F
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS,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:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-1011
Mailing Address - Country:US
Mailing Address - Phone:919-658-6053
Mailing Address - Fax:919-658-6053
Practice Address - Street 1:429 NC HIGHWAY 55 E
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1011
Practice Address - Country:US
Practice Address - Phone:919-658-6053
Practice Address - Fax:919-658-6053
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC747320KMedicaid