Individual
JOHN D ROTH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 SOUTH ST, WEST HARTFORD, CT 06110-1967
(860) 578-1300
Mailing address
615 CENTRAL AVE APT 3, NEW HAVEN, CT 06515-2124
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14361292
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/26/2019
Last updated
10/12/2020
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