Provider Demographics
NPI:1881710416
Name:ROTH, NANCY L
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
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 1:1291 S MONACO PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1811
Mailing Address - Country:US
Mailing Address - Phone:303-753-9942
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1677
Practice Address - Country:US
Practice Address - Phone:303-636-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO982014104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
017399OtherKAISER-COMMERCIAL NUMBER