Individual
MISS STACY ANNE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN, MPH
Contact information
Practice address
9039 W CHURCH ST, APT 1H, DES PLAINES, IL 60016-7008
(630) 201-3847
Mailing address
9039 W CHURCH ST, APT 1H, DES PLAINES, IL 60016-7008
(630) 201-3847
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
IL
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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