Individual
DR. HEIDI ANN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1441 S FENBROOK LN, BLOOMINGTON, IN 47401-4176
(812) 606-9996
Mailing address
3709 E TAYLOR CT, BLOOMINGTON, IN 47401-4464
(812) 606-9996
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1926
CO
101YP2500X
Professional Counselor
Primary
39002155A
IN
Other
Enumeration date
08/20/2008
Last updated
11/27/2012
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