Individual
MRS. MARY ANN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
E12155 SIDE RD, BARABOO, WI 53913-9752
(608) 209-4480
(608) 355-0527
Mailing address
E12155 SIDE RD, BARABOO, WI 53913-9752
(608) 209-4480
(608) 355-0527
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2800
NC
Other
Enumeration date
08/06/2007
Last updated
08/06/2007
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