| Doctor Name: | DR. MIA CHRISTINE HEGARTY ROACH |
| NPI Number: | 1750478483 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 1035 |
| Business Practice Address: | 1519 S Phillips St Algona, IA - 505113649 |
| Business Phone Number: | 5152957714 |
| Business Fax Number: | 5152954505 |
| Mailing Address: | 1519 S Phillips St, ALGONA |
| State: | IA |
| Postal Code: | 505113649 |
| Phone Number: | 5152957714 |
| Fax Number: | 5152954505 |
| NPI Enumeration Date: | 10/06/2006 |
| NPI Last Update Date: | 03/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1035 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |