Provider Demographics
NPI:1578210365
Name:RODENROTH, BETHANY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:RODENROTH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3558 BERMUDA AVE
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1010
Mailing Address - Country:US
Mailing Address - Phone:610-914-3000
Mailing Address - Fax:
Practice Address - Street 1:3558 BERMUDA AVE
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1010
Practice Address - Country:US
Practice Address - Phone:610-914-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist