Provider Demographics
NPI:1255640934
Name:ROSSO, JAMIE A (MA CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:ROSSO
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 ROUTE 58
Mailing Address - Street 2:PMB 322
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-553-4680
Mailing Address - Fax:
Practice Address - Street 1:3685 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933
Practice Address - Country:US
Practice Address - Phone:631-553-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020924-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist