Provider Demographics
NPI:1265710081
Name:ROSAND, CAROLYN JEAN (MS)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JEAN
Last Name:ROSAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 S PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4002
Mailing Address - Country:US
Mailing Address - Phone:253-212-2659
Mailing Address - Fax:
Practice Address - Street 1:6419 S PUGET SOUND AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4002
Practice Address - Country:US
Practice Address - Phone:253-212-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist