Provider Demographics
NPI:1972822781
Name:SOUTHARD, ROSE ANN A (MS-CF, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:ROSE ANN
Middle Name:A
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:MS-CF, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CABLE LN
Mailing Address - Street 2:CABLE LANE
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6103
Mailing Address - Country:US
Mailing Address - Phone:516-659-8031
Mailing Address - Fax:
Practice Address - Street 1:12 CABLE LN
Practice Address - Street 2:CABLE LANE
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6103
Practice Address - Country:US
Practice Address - Phone:516-659-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020049-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist