Provider Demographics
NPI:1619221223
Name:ROGGENBUCK, JENNIFER LYNN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:ROGGENBUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:BUECHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHCA
Mailing Address - Street 1:33305 1ST WAY S
Mailing Address - Street 2:SUITE B-203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6235
Mailing Address - Country:US
Mailing Address - Phone:253-235-5957
Mailing Address - Fax:
Practice Address - Street 1:33305 1ST WAY S
Practice Address - Street 2:SUITE B-203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6235
Practice Address - Country:US
Practice Address - Phone:253-235-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health