Provider Demographics
NPI:1396540126
Name:ROSENBERG, GINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9767 PACHUCA DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3185
Mailing Address - Country:US
Mailing Address - Phone:702-445-0086
Mailing Address - Fax:
Practice Address - Street 1:9767 PACHUCA DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3185
Practice Address - Country:US
Practice Address - Phone:702-445-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist