Basic Information
Provider Information
NPI: 1083969158
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSEN
FirstName: AMBER
MiddleName: JOYE
NamePrefix: DR.
NameSuffix:  
Credential: AU.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 E. SUNSET ROAD
Address2: UNIT 96595
City: LAS VEGAS
State: NV
PostalCode: 891931246
CountryCode: US
TelephoneNumber: 7027980113
FaxNumber: 8662915242
Practice Location
Address1: 5550 STERRETT PL
Address2: SUITE 100
City: COLUMBIA
State: MD
PostalCode: 210442611
CountryCode: US
TelephoneNumber: 4432184004
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2012
LastUpdateDate: 03/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X01259MDY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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