MEDICARE: EMILY RODERICK

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	2295	OK

General Provider Information

NPI Number	:	1710085931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY RODERICK

Provider Business Mailing Address
First Line	:	1305 GREYSTONE ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 HANNER HALL
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-5062
Country	:	US
Telephone Number	:	405-744-6021
Fax Number	:	405-744-8070

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ EMILY RODERICK ” Practice Location

Language	Start Address	Practice Location

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