Individual
MISS EMILY ANN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
355 W 16TH ST, SUITE 2800, INDIANAPOLIS, IN 46202-2207
(317) 963-7308
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
(317) 962-3834
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20043113A
IN
103TC2200X
Clinical Child & Adolescent Psychologist
000
—
Other
Enumeration date
05/03/2016
Last updated
02/05/2020
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