Healthcare Provider Details

I. General information

NPI: 1497758882
Provider Name (Legal Business Name): LYNNETTE J ROTH MA, FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S MYRTLE AVE
WILLARD OH
44890-1408
US

IV. Provider business mailing address

3540 BURBANK RD # 108
WOOSTER OH
44691-8539
US

V. Phone/Fax

Practice location:
  • Phone: 419-964-5380
  • Fax: 419-933-4502
Mailing address:
  • Phone: 330-621-8013
  • Fax: 330-345-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA00645
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: