Doctor Name: | MS. JULIE ANN ROTH |
NPI Number: | 1417102781 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SACIT |
License Number: | 15618-130 |
Business Practice Address: | 9415 W Forest Home Ave Suite 108 Hales Corners, WI - 531301680 |
Business Phone Number: | 4144274884 |
Business Fax Number: | 4144274889 |
Mailing Address: | 9415 W Forest Home Ave, Suite 108 HALES CORNERS |
State: | WI |
Postal Code: | 531301680 |
Phone Number: | 4144274884 |
Fax Number: | 4144274889 |
NPI Enumeration Date: | 11/30/2008 |
NPI Last Update Date: | 11/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 15618-130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |