Provider Demographics
NPI:1851476873
Name:ROESLE, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:ROESLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 FARAON ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3373
Mailing Address - Country:US
Mailing Address - Phone:816-671-4840
Mailing Address - Fax:816-671-4845
Practice Address - Street 1:5301 FARAON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3373
Practice Address - Country:US
Practice Address - Phone:816-671-4840
Practice Address - Fax:816-671-4845
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00951231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00951OtherMO AUDIOLOGY LICENSE