Provider Demographics
NPI:1194011767
Name:ROSALES, ANDREA C (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:ROSALES
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 1:950 25TH ST NW APT 815N
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2176
Mailing Address - Country:US
Mailing Address - Phone:305-582-6251
Mailing Address - Fax:
Practice Address - Street 1:1604 SPRING HILL RD FL 3
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7510
Practice Address - Country:US
Practice Address - Phone:703-546-8594
Practice Address - Fax:212-679-7868
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist