Provider Demographics
NPI:1073178729
Name:ROTH, COURTNEY ANN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1512
Mailing Address - Country:US
Mailing Address - Phone:631-935-5388
Mailing Address - Fax:
Practice Address - Street 1:73A E OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4200
Practice Address - Country:US
Practice Address - Phone:516-520-8736
Practice Address - Fax:516-433-4840
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist