Su Roth

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34010888A Issued in IN

Practice address

8633 Castle Creek Dr
Fort Wayne, IN 46804-2759

Phone

(317) 775-4994

NPI assigned

Jan 28, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, IN

  Medicare reassignment NPD
• Harmony Within LLC

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1891553889
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1265023642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8633 CASTLE CREEK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042759",
            "telephone_number": "317-775-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8633 CASTLE CREEK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042759",
            "telephone_number": "317-775-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "SU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34010888A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Ross, MD
• Helen Catherine Rossman, MS, MSED, NP-C
• Adam Roth, CO
• Daniel Christopher Roth, DO, MBA, MS
• Meredith Roth, PA-C
• Theresa L Roth, RN
• Zachary D Roth, O.D.
• Holly Nicole Rothenbush, LMFT
• Amanda Rothgeb
• Michale Diane Rothgeb, PTA

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.