Provider Demographics
NPI:1548540016
Name:SIMMONS, ROXANNE MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1421
Mailing Address - Country:US
Mailing Address - Phone:573-431-3300
Mailing Address - Fax:
Practice Address - Street 1:405 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1421
Practice Address - Country:US
Practice Address - Phone:573-431-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist