| Doctor Name: | JENNIFER ROACH |
| NPI Number: | 1003247677 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CO60335346 |
| Business Practice Address: | 2610 Wetmore Ave Everett, WA - 982012927 |
| Business Phone Number: | 4252585270 |
| Business Fax Number: | 4252585275 |
| Mailing Address: | 2610 Wetmore Ave, EVERETT |
| State: | WA |
| Postal Code: | 982012927 |
| Phone Number: | 4252585270 |
| Fax Number: | 4252585275 |
| NPI Enumeration Date: | 12/09/2013 |
| NPI Last Update Date: | 12/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CO60335346 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |