Provider Demographics
NPI:1023306701
Name:ROESCH, JULIE M (LMSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:ROESCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 SCIO CHURCH CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9259
Mailing Address - Country:US
Mailing Address - Phone:734-665-9478
Mailing Address - Fax:734-665-9489
Practice Address - Street 1:2098 SCIO CHURCH CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9259
Practice Address - Country:US
Practice Address - Phone:734-665-9478
Practice Address - Fax:734-665-9489
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010578861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical