Provider Demographics
NPI:1992475115
Name:RUBINO-FRYE, ROSA (MA, CCC-SLP, CBIS)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:RUBINO-FRYE
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 UNIVERSITY PL
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1260
Mailing Address - Country:US
Mailing Address - Phone:313-529-1823
Mailing Address - Fax:
Practice Address - Street 1:723 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1260
Practice Address - Country:US
Practice Address - Phone:313-529-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-18
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist