Provider Demographics
NPI:1144274267
Name:ROTH, SUSAN R (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:ROTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD.
Mailing Address - Street 2:SUITE 650
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-531-7637
Mailing Address - Fax:305-532-3040
Practice Address - Street 1:4302 ALTON RD.
Practice Address - Street 2:SUITE 650
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140
Practice Address - Country:US
Practice Address - Phone:305-531-7637
Practice Address - Fax:305-532-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY740231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1394YMedicare ID - Type UnspecifiedMEDICARE PROVIDER