Provider Demographics
NPI:1952197139
Name:ROACH, CINDY SUE
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:SUE
Last Name:ROACH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 S FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2117
Mailing Address - Country:US
Mailing Address - Phone:541-207-6307
Mailing Address - Fax:
Practice Address - Street 1:5353 S FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-2117
Practice Address - Country:US
Practice Address - Phone:541-207-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty