Provider Demographics
NPI:1932352226
Name:ROSE, EMILY S (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:S
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 1:4728 DEERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3759
Mailing Address - Country:US
Mailing Address - Phone:607-723-2866
Mailing Address - Fax:
Practice Address - Street 1:4728 DEERFIELD PL
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3759
Practice Address - Country:US
Practice Address - Phone:607-723-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist