Individual
BRENNON ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1890 WAITE ST STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
Mailing address
1890 WAITE ST STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C6849
OR
Other
Enumeration date
06/17/2022
Last updated
08/01/2023
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