Provider Demographics
NPI:1942682042
Name:ROTH, DEBORAH ANN (MSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34224 SE SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-9612
Mailing Address - Country:US
Mailing Address - Phone:503-781-9800
Mailing Address - Fax:
Practice Address - Street 1:34224 SE SMITH RD
Practice Address - Street 2:
Practice Address - City:CORBETT
Practice Address - State:OR
Practice Address - Zip Code:97019-9612
Practice Address - Country:US
Practice Address - Phone:503-781-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical