Provider Information for 1932407319
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Ms. MICHELE ANNE ROEDER LCPC
Other Names:Former Name:MICHELE ANNE STEPHENS LCPCSex: Female
NPI: 1932407319
Last Updated: 2023-08-18
Certification Date: 2023-08-17
Certification Date: 2023-08-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1932407319 | ||||||||
| Enumeration Date | 2011-03-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2891 W GEMSTONE DR MERIDIAN, ID 83646-1195 United States Phone: 208-936-5111 | Fax: | ||||||||
| Primary Practice Address | 9514 W FAIRVIEW AVE STE 100 BOISE, ID 83704-0614 United States Phone: 208-936-5111 | Fax: | ||||||||
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