Basic Information
| Provider Information | |||||||||
| NPI: | 1508290156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCFADDEN | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | DOMINIQUE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3712 CARRIAGE PARK LN | ||||||||
| Address2: | APT #2 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989026354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166408165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 W EMMA ST | ||||||||
| Address2: | |||||||||
| City: | UNION GAP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989031940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092481985 | ||||||||
| FaxNumber: | 5094574281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.