Provider Demographics
NPI:1194564203
Name:ROOTED INTEGRATIVE SPEECH THERAPY CENTER, PLLC
Entity type:Organization
Organization Name:ROOTED INTEGRATIVE SPEECH THERAPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH- LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DENMAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:336-281-5081
Mailing Address - Street 1:PO BOX 2358
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-2358
Mailing Address - Country:US
Mailing Address - Phone:336-281-5081
Mailing Address - Fax:855-710-6637
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2815
Practice Address - Country:US
Practice Address - Phone:336-281-5081
Practice Address - Fax:855-710-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty