Provider Demographics
NPI:1164309043
Name:ROTH, LAUREN WHELAN DEYENNO (NBC-HWC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:WHELAN DEYENNO
Last Name:ROTH
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-0102
Mailing Address - Country:US
Mailing Address - Phone:610-314-3424
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-0102
Practice Address - Country:US
Practice Address - Phone:610-314-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach