Provider Demographics
NPI:1013248988
Name:ROSEN, DAVID ALLEN (SLP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:ROSEN
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 NE 89TH ST
Mailing Address - Street 2:
Mailing Address - City:EL PORTAL
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3048
Mailing Address - Country:US
Mailing Address - Phone:786-587-4345
Mailing Address - Fax:
Practice Address - Street 1:66 NE 89TH ST
Practice Address - Street 2:
Practice Address - City:EL PORTAL
Practice Address - State:FL
Practice Address - Zip Code:33138-3048
Practice Address - Country:US
Practice Address - Phone:786-587-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist