Provider Demographics
NPI:1689798894
Name:ROESEMEIER, JANE LOIS (CAC-R)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LOIS
Last Name:ROESEMEIER
Suffix:
Gender:F
Credentials:CAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2571
Mailing Address - Country:US
Mailing Address - Phone:231-775-6581
Mailing Address - Fax:231-775-5421
Practice Address - Street 1:421 S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2571
Practice Address - Country:US
Practice Address - Phone:231-775-6581
Practice Address - Fax:231-775-5421
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI200469101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)