Individual
JEANNA MARIE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 628-9566
Mailing address
16427 BEAVER DR, BIG LAKE, MN 55309-4859
(612) 834-2318
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303934
MN
Other
Enumeration date
12/27/2022
Last updated
12/27/2022
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