Individual
JACLYN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
121 STEVEN DR, TROY, IL 62294-1866
(618) 288-3700
Mailing address
27 AUERBACH PL, GLEN CARBON, IL 62034-1596
(618) 288-3700
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043119533
IL
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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