Active NPI
Loretta M Rose
- Speech-Language Pathologist
- University Place, WA
National Provider Identifier
1902073158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 465500G
- Practice address
- 3717 Grandview Dr W
University Place, WA 98466-2138 - Phone
- (253) 566-5600
- Fax
- (253) 566-5607
- NPI assigned
- May 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 465500G | WA | Primary |
Addresses
Primary practice location
3717 Grandview Dr W
University Place, WA 98466-2138
Mailing address
3717 Grandview Dr W
University Place, WA 98466-2138
Phone (253) 566-5600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200013580A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 465500G | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350000000000",
"number": "1902073158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3717 GRANDVIEW DR W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984662138",
"telephone_number": "253-566-5600",
"fax_number": "253-566-5607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3717 GRANDVIEW DR W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984662138",
"telephone_number": "253-566-5600",
"fax_number": "253-566-5607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "LORETTA",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-15",
"last_updated": "2012-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "465500G",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200013580A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in University Place, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.