Basic Information
| Provider Information | |||||||||
| NPI: | 1275679276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AARON | ||||||||
| FirstName: | ROXANNE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | AU.D., CCC-A, FAAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016785800 | ||||||||
| FaxNumber: | 9015251282 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016785800 | ||||||||
| FaxNumber: | 9015251282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231HA2400X | 01772 | MO | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231H00000X | 1509 | TN | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 1772 | MO | N | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1515206 | 05 | TN | MEDICAID | 333348316 | 05 | MO | MEDICAID |