Individual
HAILEE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9300 NE OAK VIEW DR, VANCOUVER, WA 98662-6157
(360) 567-2211
Mailing address
11803 NE 124TH AVE APT G115, VANCOUVER, WA 98682-2094
(360) 334-1833
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
—
WA
104100000X
Social Worker
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558593350
—
WA
05
—
1861974032
—
WA
Enumeration date
09/04/2018
Last updated
12/28/2018
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