Provider Demographics
NPI:1194095992
Name:BOARDMAN, ROSANNA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:MARIE
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:ROSANNA
Other - Middle Name:MARIE
Other - Last Name:SCHENKEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4250 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4031
Mailing Address - Country:US
Mailing Address - Phone:928-373-3451
Mailing Address - Fax:928-373-3498
Practice Address - Street 1:4250 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4031
Practice Address - Country:US
Practice Address - Phone:928-373-3451
Practice Address - Fax:928-373-3498
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ643217Medicare PIN