Healthcare Provider Details

I. General information

NPI: 1962575381
Provider Name (Legal Business Name): EDNA ROIG SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 BARNUM AVE
STRATFORD CT
06614-4943
US

IV. Provider business mailing address

PO BOX 1005
STRATFORD CT
06615-8505
US

V. Phone/Fax

Practice location:
  • Phone: 203-209-4065
  • Fax: 203-540-5424
Mailing address:
  • Phone: 203-209-4065
  • Fax: 203-502-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003615
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: