Individual
MISS BRIDGETTE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30800 CHAGRIN BLVD, PEPPER PIKE, OH 44124-5925
(440) 205-2417
Mailing address
30800 CHAGRIN BLVD, PEPPER PIKE, OH 44124-5925
(216) 591-0324
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2864093
—
OH
Enumeration date
12/22/2022
Last updated
12/22/2022
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