Individual
KIM DE LA ROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MACCCSLP
Contact information
Practice address
1248 HOSPITAL DR, ST JOHNSBURY, VT 05819-9239
(802) 748-8757
Mailing address
183 TREMONT ST, ST JOHNSBURY, VT 05819-1154
(802) 274-1734
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8045629
VT
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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