Individual
MR. ROBERT JOHN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 E ENTERPRISE AVE STE B, APPLETON, WI 54913-8556
(920) 416-8577
Mailing address
1809 HICKORY LN, OSHKOSH, WI 54901-2510
(877) 300-9101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42251300
—
WI
Enumeration date
06/21/2021
Last updated
04/14/2023
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