Provider Demographics
NPI:1770786733
Name:ROSE, DARLENE JOYCE (SLP)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:JOYCE
Last Name:ROSE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13535 WRAYBURN RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-780-0493
Mailing Address - Fax:
Practice Address - Street 1:19525 W NORTH AVENUE
Practice Address - Street 2:WHEATON FRANCISCAN HEALTHCARE MARIAN FRANCISCAN SERVICE
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-785-1114
Practice Address - Fax:262-780-3805
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI525154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42602100Medicaid