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NPI Code Detail

MEDICARE: LISA ROTROFF

MEDICARE: LISA ROTROFF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1477003804
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ROTROFF
Provider Business Mailing Address
First Line : PO BOX 809
Second Line :
City : GOSHEN
State : IN
Zip : 46527-0809
Country : US
Telephone Number : 574-533-1234
Fax Number : 574-537-2652
Provider Business Practice Location Address
First Line : 62226 COUNTY ROAD 15
Second Line :
City : GOSHEN
State : IN
Zip : 46526-9438
Country : US
Telephone Number : 574-533-1234
Fax Number : 574-537-2652
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2016
Last Update Date : 10/10/2016

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Directions to “ LISA ROTROFF ” Practice Location

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