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General NPI Number Information
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NPI Number | 1093689937
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Entity Type | Organization
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Legal Business Name | STRONG ROOTS PEDIATRIC SPEECH THERAPY WELLNESS PLLC
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 888 LONG POND RD STE 4
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City | ROCHESTER
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State | NY
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Zip | 14626-1111
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Country | US
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Telephone | 585-478-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 888 LONG POND RD STE 4
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City | GREECE
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State | NY
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Zip | 14626-1111
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Country | US
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Telephone | 585-478-0603
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST, OWNER
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Name | RACHEL MACMULLEN
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Credential | M.S. CCC-SLP
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Telephone | 585-478-0603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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