Provider Demographics
NPI:1619133220
Name:ROARK, WENDY LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEIGH
Last Name:ROARK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2211
Mailing Address - Country:US
Mailing Address - Phone:479-445-4192
Mailing Address - Fax:
Practice Address - Street 1:6 DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7820
Practice Address - Country:US
Practice Address - Phone:610-849-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2052235Z00000X
PASL011034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist