Provider Demographics
NPI:1841825643
Name:ROE, YULIA (LICSW)
Entity type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 NW 62ND CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2456
Mailing Address - Country:US
Mailing Address - Phone:404-314-1820
Mailing Address - Fax:
Practice Address - Street 1:1301 N WAREHOUSE RD
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2364
Practice Address - Country:US
Practice Address - Phone:404-314-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190369001041C0700X
VA09040148251041C0700X
AL4265C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical