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Individual

JENNA A. DEROSA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5175 SUNSET BLVD STE M, LEXINGTON, SC 29072-7319
(803) 359-3195
Mailing address
578 DUDLEY DR, FORT MILL, SC 29715-9804

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary

Other

Enumeration date
10/17/2018
Last updated
10/17/2018
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