Provider Demographics
NPI:1396565800
Name:ROSENBAUM, MIRIAM (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:ZERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4158
Mailing Address - Country:US
Mailing Address - Phone:443-635-1366
Mailing Address - Fax:
Practice Address - Street 1:1500 AVENUE OF THE STATES
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4789
Practice Address - Country:US
Practice Address - Phone:732-961-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01289500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist