Healthcare Provider Details

I. General information

NPI: 1619871647
Provider Name (Legal Business Name): ROOTED PATHWAYS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 PORTSMOUTH AVE
GREENLAND NH
03840-2257
US

IV. Provider business mailing address

440 MICOL RD
PEMBROKE NH
03275-3114
US

V. Phone/Fax

Practice location:
  • Phone: 978-766-1620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNA NOLIN
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 978-766-1620