Provider Demographics
NPI:1972268704
Name:ROMMEL, JENNIFER KOCH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KOCH
Last Name:ROMMEL
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 1:1207 OLD LOVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2351
Mailing Address - Country:US
Mailing Address - Phone:410-353-1026
Mailing Address - Fax:
Practice Address - Street 1:202 COURSEVALL DR STE 104
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2805
Practice Address - Country:US
Practice Address - Phone:443-262-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2550101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)