Provider Demographics
NPI:1023055621
Name:WORTHINGTON-ROACH, ERIN LEE (CCC, SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:WORTHINGTON-ROACH
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WHITE PINE CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1984
Mailing Address - Country:US
Mailing Address - Phone:410-960-0879
Mailing Address - Fax:
Practice Address - Street 1:42 WHITE PINE CT
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1984
Practice Address - Country:US
Practice Address - Phone:410-960-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ3865235Z00000X
MD05535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist