Provider Demographics
NPI:1659449866
Name:ROTH, CAROLE R (PHD, CCC, BC-ANCDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:R
Last Name:ROTH
Suffix:
Gender:F
Credentials:PHD, CCC, BC-ANCDS
Other - Prefix:DR
Other - First Name:CAROLE
Other - Middle Name:R
Other - Last Name:ROTH-ABRAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, CCC, BC-ANCDS
Mailing Address - Street 1:645 FRONT ST UNIT 1305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7086
Mailing Address - Country:US
Mailing Address - Phone:858-395-2676
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-7086
Practice Address - Country:US
Practice Address - Phone:619-532-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 3455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist