Individual
DR. AMANDA MARIE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
120 W 7TH ST, BLOOMINGTON, IN 47404-3834
(812) 929-4593
(812) 961-6551
Mailing address
3849 S CRAMER CIR, BLOOMINGTON, IN 47403-8997
(812) 929-4593
(812) 961-6551
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20043515A
IN
Other
Enumeration date
09/15/2021
Last updated
05/06/2023
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