Provider Demographics
NPI:1649456393
Name:ROSA, ANGELENA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELENA
Middle Name:MARIE
Last Name:ROSA
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 1:7781 PLANTATION CIR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2067
Mailing Address - Country:US
Mailing Address - Phone:727-871-4287
Mailing Address - Fax:
Practice Address - Street 1:6215 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6708
Practice Address - Country:US
Practice Address - Phone:941-755-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA11829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist