Individual provider Active NPI

Victoria Ann Rosdahl

  • Speech-Language Pathologist
  • Kenmore, NY
National Provider Identifier
1932698115
Registry record updated May 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
2900 Delaware Ave
Kenmore, NY 14217-2309
Phone
(716) 871-9883
NPI assigned
May 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

2900 Delaware Ave
Kenmore, NY 14217-2309

Mailing address

2900 Delaware Ave
Kenmore, NY 14217-2309
Phone (716) 871-9883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190506001677 NY Practitioner - Qualified Speech Language Pathologist 7315289725

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
028570NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Diversified Services for Occupational Therapy, Physical Ther Speech-Language Pathologist CurrentSince May 15, 2019 Accepting new patients
Diversified Services for Occupational Therapy, Physical Therapy, Speec CurrentSince May 15, 2019 Accepting new patients

Locations

2900 Delaware Ave
Kenmore, NY 14217
Phone (716) 262-9791

17 Limestone Dr
Ste 5
Williamsville, NY 14221
Phone (716) 362-1552

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1932698115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172309",
            "telephone_number": "716-871-9883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172309",
            "telephone_number": "716-871-9883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSDAHL",
        "first_name": "VICTORIA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-03",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenmore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.