Provider Demographics
NPI:1316963069
Name:ROQUEMORE, LYNETTE F (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:F
Last Name:ROQUEMORE
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 1:2127 SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2815
Mailing Address - Country:US
Mailing Address - Phone:937-308-3789
Mailing Address - Fax:
Practice Address - Street 1:2127 SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-2815
Practice Address - Country:US
Practice Address - Phone:937-308-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist