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NPI Code Detail

MEDICARE: JULIE ROTH, PLLC

MEDICARE: JULIE ROTH, PLLC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1891379509
Entity Type Code : Organization
Provider Name (Legal Business Name) : JULIE ROTH, PLLC
Provider Business Mailing Address
First Line : 147 MAPLE RIDGE DR
Second Line :
City : MORTON
State : IL
Zip : 61550-1121
Country : US
Telephone Number : 309-712-6396
Fax Number :
Provider Business Practice Location Address
First Line : 208 S 1ST AVE
Second Line :
City : MORTON
State : IL
Zip : 61550-2044
Country : US
Telephone Number : 309-585-6061
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JULIE ROTH
Credential : LCPC
Telephone Number : 309-585-6061
Provider Enumeration Date : 05/09/2021
Last Update Date : 05/09/2021

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