Provider Demographics
NPI:1932619566
Name:LA ROSA, GISELLE MARIA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:MARIA
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6191 ORANGE DR STE 6181P
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3457
Mailing Address - Country:US
Mailing Address - Phone:954-800-4078
Mailing Address - Fax:954-369-1444
Practice Address - Street 1:6191 ORANGE DR STE 6181P
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3457
Practice Address - Country:US
Practice Address - Phone:954-800-4078
Practice Address - Fax:954-369-1444
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist