=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407789951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY L ROOT MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3045 SANTIAGO ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-241-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 JOHNSON ST APT B
-----------------------------------------------------
City | SAUSALITO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94965-2274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-301-9879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 21410
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------