Provider Demographics
NPI:1972973287
Name:ROSE, PATRICIA ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:KUNTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:704 FORTINO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2086
Mailing Address - Country:US
Mailing Address - Phone:719-305-8300
Mailing Address - Fax:719-305-9723
Practice Address - Street 1:704 FORTINO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2086
Practice Address - Country:US
Practice Address - Phone:719-305-8300
Practice Address - Fax:719-305-9723
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist