Terri Alene Roth | Salt Lake City, UT • PECOS Search

Terri Alene Roth

Social Worker

Behavioral Health & Social Service Providers

5965 S 900 E, Salt Lake City, UT 84121-1720

PECOS Enrollment

Based on the most recent information from CMS, provider Terri Alene Roth does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1447513551
Provider Type
Individual
Full Name
Roth, Terri Alene
Gender
Female

Sole Proprietor
No
Enumeration Date
6/22/2012
Last Updated
9/18/2014

Contact Information

Practice Location

5965 S 900 E, Salt Lake City, UT 84121-1720

Unlisted Fax

Mailing Location

5965 S 900 E, Salt Lake City, UT 84121-1720

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 7505371-3502 Utah