Basic Information
| Provider Information | |||||||||
| NPI: | 1376852582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN DER JAGT | ||||||||
| FirstName: | ROSEMARIE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.A. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 SAXONY RD | ||||||||
| Address2: | |||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145343050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857276923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 BENTON DR | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960032151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302436317 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 05/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 18563 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.