Provider Demographics
NPI:1841385689
Name:ROETTGER, GLORIA J (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:ROETTGER
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 STATE AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4764
Mailing Address - Country:US
Mailing Address - Phone:360-236-1346
Mailing Address - Fax:360-956-7455
Practice Address - Street 1:2222 STATE AVE NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4764
Practice Address - Country:US
Practice Address - Phone:360-236-1346
Practice Address - Fax:360-956-7455
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH3672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health