Provider Demographics
NPI:1811466188
Name:ROTH, ILANA PEARL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:PEARL
Last Name:ROTH
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 1:8200 SAVAGE GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-5671
Mailing Address - Country:US
Mailing Address - Phone:410-880-5920
Mailing Address - Fax:
Practice Address - Street 1:8200 SAVAGE GUILFORD RD
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:20763-5671
Practice Address - Country:US
Practice Address - Phone:410-880-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist