Provider Demographics
NPI:1538219597
Name:EPPS, ROSHONDA N (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROSHONDA
Middle Name:N
Last Name:EPPS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9723 NORTHCROSS CENTER CT STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7301
Mailing Address - Country:US
Mailing Address - Phone:704-268-9658
Mailing Address - Fax:
Practice Address - Street 1:9723 NORTHCROSS CENTER CT STE D
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7301
Practice Address - Country:US
Practice Address - Phone:704-268-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006014616174400000X
GASLP008819235Z00000X
NC11303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1538219597Medicaid