Provider Demographics
NPI:1922823277
Name:ROSENHAVE, ELISE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:ROSENHAVE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33541 RICKETTS RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9767
Mailing Address - Country:US
Mailing Address - Phone:971-238-4668
Mailing Address - Fax:
Practice Address - Street 1:1350 TEAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2537
Practice Address - Country:US
Practice Address - Phone:541-269-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty