Provider Demographics
NPI:1487982948
Name:ROSENER, SAMUEL JOSEPH (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:ROSENER
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6989 IRONRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4467
Mailing Address - Country:US
Mailing Address - Phone:909-234-6454
Mailing Address - Fax:
Practice Address - Street 1:6989 IRONRIDGE CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4467
Practice Address - Country:US
Practice Address - Phone:909-234-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist