Lily Jeannine Roach, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

030792 Issued in NY

Practice address

116 Volney St
Phoenix, NY 13135-3104

Phone

(315) 695-1555

NPI assigned

Jun 8, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Gorge Falls Therapy SLP, OT, PLLC

  • Early Intervention Provider Agency
  • Ithaca, NY
  • NPI 1295258689
  NPD (past)
• Gorge Falls Therapy SLP, OT, PLLC

  • Early Intervention Provider Agency
  • Ithaca, NY
  • NPI 1821556358

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1649894445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 VOLNEY ST",
            "city": "PHOENIX",
            "state": "NY",
            "postal_code": "131353104",
            "telephone_number": "315-695-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 VOLNEY ST",
            "city": "PHOENIX",
            "state": "NY",
            "postal_code": "131353104",
            "telephone_number": "315-695-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "LILY",
        "middle_name": "JEANNINE",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-08",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "030792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoenix Central School District
• Phoenix Central Schools
• Jennifer Maynard Pratt
• April Quill
• Courtney Lynn Ricard
• SG Dental, PC
• Douglas Shearer, RN, BSN,BLS
• Suzan Mary Elizabeth Sheldon
• Mary E Smith
• Patricia Irene Smith, LPN

• Speech-Language Pathologist in Phoenix, NY
• Providers in Phoenix, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.