MEDICARE: LISA ROTHBERGER SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP004187	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487632758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ROTHBERGER SLP

Provider Business Mailing Address
First Line	:	6627 GUNSTOCK LN
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-1436
Country	:	US
Telephone Number	:	404-575-4000
Fax Number	:	404-575-4010

Provider Business Practice Location Address
First Line	:	842 N HIGHLAND AVE NE
Second Line	:	SUITE 275
City	:	ATLANTA
State	:	GA
Zip	:	30306-4530
Country	:	US
Telephone Number	:	404-575-4000
Fax Number	:	404-575-4010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	12/21/2010

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Directions to “ LISA ROTHBERGER SLP” Practice Location

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