Provider Demographics
NPI:1891072021
Name:ROAT, ELIZABETH JEANNE (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JEANNE
Last Name:ROAT
Suffix:
Gender:F
Credentials:MA, CCC/SLP
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Mailing Address - Street 1:4034 WARNER RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9328
Mailing Address - Country:US
Mailing Address - Phone:315-926-2300
Mailing Address - Fax:315-926-5797
Practice Address - Street 1:3863 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9579
Practice Address - Country:US
Practice Address - Phone:315-926-4256
Practice Address - Fax:315-926-3115
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5334-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist