Provider Demographics
NPI:1477293629
Name:ROLLER, JESSIE CZERWONKA (LPC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:CZERWONKA
Last Name:ROLLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16609 PROSPECT LN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4686
Mailing Address - Country:US
Mailing Address - Phone:303-746-3442
Mailing Address - Fax:
Practice Address - Street 1:16609 PROSPECT LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-4686
Practice Address - Country:US
Practice Address - Phone:303-746-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty