Individual
MARIAH JEAN ROUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 NW KELLY DR STE A, PARKVILLE, MO 64152-4027
(816) 469-5162
Mailing address
4807 LAKEWOOD RDG, MANHATTAN, KS 66503-8403
(785) 844-3055
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-45376
KS
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/14/2017
Last updated
02/11/2022
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