MEDICARE: EMILY MIYOKO ROTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		KS

General Provider Information

NPI Number	:	1073250460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MIYOKO ROTH

Provider Business Mailing Address
First Line	:	3017 S DUNCAN ST
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-5622
Country	:	US
Telephone Number	:	316-847-1698
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W 24TH ST STE A
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-8073
Country	:	US
Telephone Number	:	316-804-7240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	03/13/2026

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Directions to “ EMILY MIYOKO ROTH ” Practice Location

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