Provider Demographics
NPI:1396195111
Name:ROTH, NOELLE (AUD)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:
Other - Last Name:RADKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2226 NELSON HWY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9637
Mailing Address - Country:US
Mailing Address - Phone:849-742-1419
Mailing Address - Fax:
Practice Address - Street 1:2226 NELSON HWY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9637
Practice Address - Country:US
Practice Address - Phone:849-742-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12012231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist