Individual
KHADIJAH VICTORIA ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A SLPA
Contact information
Practice address
297 N BROAD ST, BROOKSVILLE, FL 34601-2925
(352) 796-0069
(352) 796-9194
Mailing address
1955 CRAPE MYRTLE LOOP APT 102, LUTZ, FL 33549-4011
(561) 713-3308
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
—
—
Other
Enumeration date
10/14/2019
Last updated
10/14/2019
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