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General NPI Number Information
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NPI Number | 1245866433
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Entity Type | Individual
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Provider Name | BARBARA EDESON ROTH MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | THE NATHANIEL WITHERELL HOME 70 PARSONAGE ROAD
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City | GREENWICH
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State | CT
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Zip | 06830
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Country | US
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Telephone | 203-618-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 220 CHESTNUT ST APT 1C
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City | PORT CHESTER
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State | NY
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Zip | 10573-3140
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Country | US
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Telephone | 914-565-9677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 004069-01
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License Number State | NY
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