Provider Demographics
NPI:1174516710
Name:ROTH, CAREN ANN (LISW)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:CAREN
Other - Middle Name:ANN
Other - Last Name:RESCHLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 E ALTA VISTA AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH COUNSELING SERVICES
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1413
Mailing Address - Country:US
Mailing Address - Phone:641-684-3135
Mailing Address - Fax:641-684-3198
Practice Address - Street 1:312 E ALTA VISTA AVE
Practice Address - Street 2:BEHAVIORAL HEALTH COUNSELING SERVICES
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1413
Practice Address - Country:US
Practice Address - Phone:641-684-3135
Practice Address - Fax:641-684-3198
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02478104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA69566OtherIOWA HEALTH SOLUTIONS
IA42068106071OtherUNITED BEHAVIORAL HEALTH
IA0268607Medicaid
IA48693OtherWELLMARK INC BCBS OF IOWA
IAUNKOtherTRIWEST
IA42068106071OtherJOHN DEERE HEALTH
IA42068106071OtherJOHN DEERE HEALTH
IAUNKOtherTRIWEST