Provider Demographics
NPI:1588857221
Name:ROSSOW, ALICIA M (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:M
Last Name:ROSSOW
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 1:1728 FORT GRANT DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7818
Mailing Address - Country:US
Mailing Address - Phone:512-636-1649
Mailing Address - Fax:512-388-7962
Practice Address - Street 1:1728 FORT GRANT DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-7818
Practice Address - Country:US
Practice Address - Phone:512-636-1649
Practice Address - Fax:512-388-7962
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist