Individual
MRS. ELLEN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
9 HEARTLAND DR STE C, BLOOMINGTON, IL 61704-7733
(309) 663-7643
(309) 663-8359
Mailing address
9 HEARTLAND DR STE C, BLOOMINGTON, IL 61704-7733
(309) 663-7643
(309) 663-8359
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164000669
IL
Other
Enumeration date
11/11/2014
Last updated
11/11/2014
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