Individual
JESSICA ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5126 CANNON BLUFF DR, WOODBRIDGE, VA 22192-5741
(203) 641-4127
Mailing address
12 MCMILLION DR, STAFFORD, VA 22554-2921
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/19/2024
Last updated
11/20/2024
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