Provider Demographics
NPI:1497758882
Name:ROTH, LYNNETTE J (MA, FAAA)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:J
Last Name:ROTH
Suffix:
Gender:F
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 BURBANK RD # 108
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8539
Mailing Address - Country:US
Mailing Address - Phone:330-621-8013
Mailing Address - Fax:330-345-1187
Practice Address - Street 1:218 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1408
Practice Address - Country:US
Practice Address - Phone:419-964-5380
Practice Address - Fax:419-933-4502
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00645237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO0792703Medicare ID - Type UnspecifiedAUDIOLOGIST
OHRO0792702Medicare ID - Type UnspecifiedMAIN PRACTICE