Provider Demographics
NPI:1134544216
Name:ROSEN, LEAH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ROSEN
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 1:24 THATCHER ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3231
Mailing Address - Country:US
Mailing Address - Phone:978-204-2250
Mailing Address - Fax:
Practice Address - Street 1:24 THATCHER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-3231
Practice Address - Country:US
Practice Address - Phone:978-204-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist