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General NPI Number Information
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NPI Number | 1033546866
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Entity Type | Organization
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Legal Business Name | ROARK AND ROARK INC.
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Dates
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Enumeration Date | 10/13/2013
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Last Update Date | 10/13/2013
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Provider Practice Location Address
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Address Line | 922B S EISENHOWER DR
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City | BECKLEY
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State | WV
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Zip | 25801-6324
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Country | US
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Telephone | 304-228-4895
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Fax |
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Provider Business Mailing Address
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Address Line | 359 COUNTRY ROADS ESTS
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City | SHADY SPRING
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State | WV
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Zip | 25918-8198
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Country | US
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Telephone | 304-228-4895
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY ROARK
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Credential | M.A. CCC-SLP
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Telephone | 304-228-4895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP-1132
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License Number State | WV
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