Individual
JOHANNA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
23770 HOSPITAL ST, CASSOPOLIS, MI 49031-9644
(269) 445-3801
Mailing address
52054 JOHNSON RD, THREE RIVERS, MI 49093-9755
(260) 433-0813
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101004407
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7101004407
SPEECH LANGUAGE PATHOLOGIST LICENSE
MI
Enumeration date
01/03/2019
Last updated
01/03/2019
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