Provider Demographics
NPI:1154678191
Name:GUTIERREZ VANEGAS, ROSA IRENE (MSSLP)
Entity type:Individual
Prefix:
First Name:ROSA IRENE
Middle Name:
Last Name:GUTIERREZ VANEGAS
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BROAD ST APT 665
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3376
Mailing Address - Country:US
Mailing Address - Phone:202-374-8192
Mailing Address - Fax:
Practice Address - Street 1:307 E ANNANDALE RD # 208
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2454
Practice Address - Country:US
Practice Address - Phone:202-417-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022450235Z00000X
VA2202007901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist