Individual
JILL ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
134 OLD MOSS CIR, DELAND, FL 32724-7820
(662) 571-9534
Mailing address
134 OLD MOSS CIR, DELAND, FL 32724-7820
(662) 571-9534
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1822
AL
Other
Enumeration date
11/29/2022
Last updated
11/29/2022
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