Provider Demographics
NPI:1174675151
Name:ROACH, JENNIFER INEZ (BA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:INEZ
Last Name:ROACH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:INEZ
Other - Last Name:HENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5455 ALMIRA DR SE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8330
Mailing Address - Country:US
Mailing Address - Phone:360-479-4994
Mailing Address - Fax:360-404-4011
Practice Address - Street 1:5455 ALMIRA DR SE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8330
Practice Address - Country:US
Practice Address - Phone:360-479-4994
Practice Address - Fax:360-404-4011
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor