| NPI | 1316835143 |
|---|---|
| Former Name | JESSICA MARIE ROTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 24-CRM-3914) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 112914) |
| Enumeration Date | 2025-06-27 |
| Last Update Date | 2025-07-09 |