Provider Demographics
NPI:1104947373
Name:ROTHSTEIN, JOSEPH A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:ROTHSTEIN
Suffix:
Gender:M
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 1:1247 LINCOLN BLVD
Mailing Address - Street 2:#284
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1703
Mailing Address - Country:US
Mailing Address - Phone:310-487-5142
Mailing Address - Fax:310-399-2264
Practice Address - Street 1:1933 12TH ST
Practice Address - Street 2:APT. A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4649
Practice Address - Country:US
Practice Address - Phone:310-487-5142
Practice Address - Fax:310-399-2264
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist