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General NPI Number Information
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NPI Number | 1336224989
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Entity Type | Individual
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Provider Name | DONALD NORMAN ROTH PSY. D., APNP
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 13500 WATERTOWN PLANK ROAD
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City | ELM GROVE
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State | WI
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Zip | 53122-2222
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Country | US
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Telephone | 847-340-5785
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 9TH AVENUE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-3216
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Country | US
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Telephone | 847-340-5785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7902-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2724-57
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License Number State | WI
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