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NPI Code Detail

MEDICARE: THOMAS M ROARK MS, CCC-SLP

MEDICARE: THOMAS M ROARK MS, CCC-SLP
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
1235Z00000XSpeech-Language Pathologist848NE

General Provider Information

NPI Number : 1205114030
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS M ROARK MS, CCC-SLP
Provider Business Mailing Address
First Line : 7503 N 76TH AVE
Second Line :
City : OMAHA
State : NE
Zip : 68122-5416
Country : US
Telephone Number : 402-616-4192
Fax Number : 402-932-1888
Provider Business Practice Location Address
First Line : 3110 SCOTT CIR
Second Line :
City : OMAHA
State : NE
Zip : 68112-2604
Country : US
Telephone Number : 402-203-6112
Fax Number : 402-932-1888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2011
Last Update Date : 07/27/2011

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Directions to “ THOMAS M ROARK MS, CCC-SLP” Practice Location

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