Provider Demographics
NPI:1891703963
Name:ROE, JEAN E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:E
Last Name:ROE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2S778 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2728
Mailing Address - Country:US
Mailing Address - Phone:630-393-0268
Mailing Address - Fax:
Practice Address - Street 1:113 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4947
Practice Address - Country:US
Practice Address - Phone:630-415-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical