Provider Demographics
NPI:1588991244
Name:ROSE, BONNIE (S/LP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:S/LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1310
Mailing Address - Country:US
Mailing Address - Phone:302-697-8805
Mailing Address - Fax:
Practice Address - Street 1:193 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1310
Practice Address - Country:US
Practice Address - Phone:302-697-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0001130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist