Provider Demographics
NPI:1427448950
Name:ROSENBERG, JULIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
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 1:54 BLACK TWIG PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1835
Mailing Address - Country:US
Mailing Address - Phone:203-273-6794
Mailing Address - Fax:
Practice Address - Street 1:76 PROGRESS DR
Practice Address - Street 2:BUSINESS SUITE 230B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3600
Practice Address - Country:US
Practice Address - Phone:203-273-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT120877OtherASHA
CT3669OtherCT DEPT OF HEALTH