MEDICARE: MELISSA S ROTH MSCCCSLP

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	235Z00000X	Speech-Language Pathologist	13497	NC

General Provider Information

NPI Number	:	1366582033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA S ROTH MSCCCSLP

Provider Business Mailing Address
First Line	:	1326 E WASHINGTON ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-1840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17213 RIDER WOOD LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8639
Country	:	US
Telephone Number	:	864-483-5403
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/20/2026

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