Provider Demographics
NPI:1376857037
Name:ROACH, DARLASUE KATRICE (SLP)
Entity Type:Individual
Prefix:MS
First Name:DARLASUE
Middle Name:KATRICE
Last Name:ROACH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118B SAWYER BROWN RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1402
Mailing Address - Country:US
Mailing Address - Phone:615-835-3119
Mailing Address - Fax:
Practice Address - Street 1:8118B SAWYER BROWN RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1402
Practice Address - Country:US
Practice Address - Phone:615-835-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3803235Z00000X
TN5083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist