Provider Demographics
NPI:1265756159
Name:ROSE, MERIDITH MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MERIDITH
Middle Name:MICHELLE
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 1:3465 DULUTH HIGHWAY 120 APT 5417
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3457
Mailing Address - Country:US
Mailing Address - Phone:561-670-3545
Mailing Address - Fax:
Practice Address - Street 1:3465 DULUTH HIGHWAY 120 APT 5417
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3457
Practice Address - Country:US
Practice Address - Phone:561-670-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9701235Z00000X
GASLP008545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist