Provider Demographics
NPI:1003868274
Name:ROEDIGER, JILL E (LADC, CADC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:ROEDIGER
Suffix:
Gender:F
Credentials:LADC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6397
Mailing Address - Country:US
Mailing Address - Phone:860-443-0036
Mailing Address - Fax:860-443-4284
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5738
Practice Address - Country:US
Practice Address - Phone:860-892-9002
Practice Address - Fax:860-892-9009
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)