Provider Demographics
NPI:1720298078
Name:ROETHER, PATRICIA D (JIO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:ROETHER
Suffix:
Gender:F
Credentials:JIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SIX FLAGS CIR
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9519
Mailing Address - Country:US
Mailing Address - Phone:805-693-1950
Mailing Address - Fax:
Practice Address - Street 1:2121 CENTERPOINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1331
Practice Address - Country:US
Practice Address - Phone:805-739-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor