Provider Demographics
NPI:1205983145
Name:ROTHLISBERGER, ANN R (LICENSED CLINICAL PR)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:R
Last Name:ROTHLISBERGER
Suffix:
Gender:F
Credentials:LICENSED CLINICAL PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 N 300 W
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4203
Mailing Address - Country:US
Mailing Address - Phone:410-852-8459
Mailing Address - Fax:801-544-6558
Practice Address - Street 1:447 N 300 W
Practice Address - Street 2:SUITE 7
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4203
Practice Address - Country:US
Practice Address - Phone:410-852-8459
Practice Address - Fax:801-544-6558
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91974956004101YM0800X
MDLCPC0948101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral