Provider Demographics
NPI:1942891304
Name:ROTH, LINDSEY ELLEN (RD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ELLEN
Last Name:ROTH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 DONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4778
Mailing Address - Country:US
Mailing Address - Phone:973-459-1135
Mailing Address - Fax:
Practice Address - Street 1:1932 DONOVAN DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4778
Practice Address - Country:US
Practice Address - Phone:973-459-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered