Provider Demographics
NPI:1942551023
Name:ROELL, JENNIFER ANN (TSHH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:ROELL
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SOUTHWESTERN DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-2117
Mailing Address - Country:US
Mailing Address - Phone:716-338-0668
Mailing Address - Fax:866-694-4979
Practice Address - Street 1:140 SOUTHWESTERN DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-2117
Practice Address - Country:US
Practice Address - Phone:716-338-0668
Practice Address - Fax:866-694-4979
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist