Provider Demographics
NPI:1558053017
Name:ROOTED SPEECH THERAPY, PLLC
Entity Type:Organization
Organization Name:ROOTED SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DENAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:562-331-4631
Mailing Address - Street 1:723 TIMBERLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4121
Mailing Address - Country:US
Mailing Address - Phone:562-331-4631
Mailing Address - Fax:
Practice Address - Street 1:723 TIMBERLAKE CIR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4121
Practice Address - Country:US
Practice Address - Phone:562-331-4631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care