Healthcare Provider Details

I. General information

NPI: 1255402848
Provider Name (Legal Business Name): PATRICIA DIANE ROH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E BELL ST
NEENAH WI
54956-4993
US

IV. Provider business mailing address

119 E BELL ST
NEENAH WI
54956-4993
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-1768
  • Fax: 920-969-1788
Mailing address:
  • Phone: 920-969-1768
  • Fax: 920-969-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number292-156
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number292-156
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number292-156
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number292156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: