Provider Demographics
NPI:1184809238
Name:ROSE, EMILY MARA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARA
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 1:400 UNIVERSITY HALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-0001
Mailing Address - Country:US
Mailing Address - Phone:828-262-2185
Mailing Address - Fax:
Practice Address - Street 1:400 UNIVERSITY HALL DRIVE
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0001
Practice Address - Country:US
Practice Address - Phone:828-262-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000817000Medicaid