Provider Demographics
NPI:1962792978
Name:ROTH, BRITTANY LAUREN (AUD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LAUREN
Last Name:ROTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 YORK AVE.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5615
Mailing Address - Country:US
Mailing Address - Phone:330-726-3339
Mailing Address - Fax:330-726-0482
Practice Address - Street 1:126 YORK AVE.
Practice Address - Street 2:SUITE 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5615
Practice Address - Country:US
Practice Address - Phone:330-726-3339
Practice Address - Fax:330-726-0482
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01767231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2915199Medicaid
OHAU9367491Medicare PIN