Jeanette Marie Roth, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12318 Issued in NC

Practice address

3901 Wrightsville Ave Ste 120
Wilmington, NC 28403-6256

Phone

(910) 679-8385

Fax

(910) 679-8385

NPI assigned

Aug 2, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Paragon Outpatient Rehabilitation Services, LLC

  • Rehabilitation Clinic/Center
  • Roxboro, NC
  • NPI 1245014380
  NPD
• Paragon Outpatient Rehabilitation Services, LLC

  • Rehabilitation Clinic/Center
  • Louisville, KY
  • NPI 1871867325
  NPD
• Coastal Occupational Therapy

  • Early Intervention Provider Agency
  • Wilmington, NC
  • NPI 1821467499
  NPD (past)
• Coastal Speech and Reading Center

  • Speech-Language Pathologist
  • Lumberton, NC
  • NPI 1649626466
  NPD (past)

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1477077303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 PRIMIVERA CT",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284094869",
            "telephone_number": "908-415-0895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 WRIGHTSVILLE AVE STE 120",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036256",
            "telephone_number": "910-679-8385",
            "fax_number": "910-679-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JEANETTE",
        "middle_name": "MARIE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00494500",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "12318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jelesa Ross Sanders, BSN, RN, ERRN
• Austin Andrew Ross, DO
• Courtney Huffman Ross, LCSW, LCAS
• Sara C Ross, LCSWA
• Jeffrey Allen Rossi
• Cherry Norris Roughton, RPH
• Emily Rowe
• Malorie Rowe, LCSW
• Carly Rowen, LCMHCA
• Diana Rowland

• Speech-Language Pathologist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.