Provider Demographics
NPI:1851791701
Name:ROEHE, GENA WALLS (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:WALLS
Last Name:ROEHE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 PLEASANT ACRES DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-7336
Mailing Address - Country:US
Mailing Address - Phone:757-439-6875
Mailing Address - Fax:
Practice Address - Street 1:6161 KEMPSVILLE CIR STE 340
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3950
Practice Address - Country:US
Practice Address - Phone:757-793-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001212231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner