Provider Demographics
NPI:1962609891
Name:PENDLEY, ROSEMARY HELEN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:HELEN
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-9301
Mailing Address - Country:US
Mailing Address - Phone:812-838-6554
Mailing Address - Fax:812-838-9685
Practice Address - Street 1:1415 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-9301
Practice Address - Country:US
Practice Address - Phone:812-838-6554
Practice Address - Fax:812-838-9685
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001454A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155342Medicaid