Provider Demographics
NPI:1962756338
Name:ROTH, BETSY ANN
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5387
Mailing Address - Country:US
Mailing Address - Phone:360-751-5023
Mailing Address - Fax:
Practice Address - Street 1:132 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5387
Practice Address - Country:US
Practice Address - Phone:360-751-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant