Individual
DONALD NORMAN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY. D., APNP
Contact information
Practice address
13500 WATERTOWN PLANK ROAD, ELM GROVE, WI 53122-2222
(847) 340-5785
Mailing address
2630 9TH AVENUE, SOUTH MILWAUKEE, WI 53172-3216
(847) 340-5785
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2724-57
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
7902-33
WI
Other
Enumeration date
10/25/2006
Last updated
11/30/2022
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