Healthcare Provider Details

I. General information

NPI: 1235775040
Provider Name (Legal Business Name): CAROLYN ROATH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 10/29/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 STAR FLOWER DR
HASLETT MI
48840-8695
US

IV. Provider business mailing address

5505 STAR FLOWER DR
HASLETT MI
48840-8695
US

V. Phone/Fax

Practice location:
  • Phone: 517-242-4426
  • Fax:
Mailing address:
  • Phone: 517-242-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLYN T ROATH
Title or Position: OWNER
Credential: LMSW
Phone: 517-242-4426