Provider Demographics
NPI:1144044975
Name:ROOT, CARSON
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 E 42ND ST S STE 220
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4700
Mailing Address - Country:US
Mailing Address - Phone:816-478-7800
Mailing Address - Fax:816-478-7839
Practice Address - Street 1:14500 E 42ND ST S STE 220
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4700
Practice Address - Country:US
Practice Address - Phone:816-478-7800
Practice Address - Fax:816-478-7839
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230196812355S0801X
MO2025014017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant