Doctor Name: | JILL E ROEDIGER |
NPI Number: | 1003868274 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.A.D.C., C.A.D.C. |
License Number: | 000166 |
Business Practice Address: | 110 Main St Norwich, CT - 063605738 |
Business Phone Number: | 8608929002 |
Business Fax Number: | 8608929009 |
Mailing Address: | 165 State St, Suite 200 NEW LONDON |
State: | CT |
Postal Code: | 063206397 |
Phone Number: | 8604430036 |
Fax Number: | 8604434284 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 000166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |