Provider Demographics
NPI:1487177085
Name:ROEBER, IAN M (MSW)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:M
Last Name:ROEBER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-1208
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:970-252-3208
Practice Address - Street 1:1175 GRAND AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:NORWOOD
Practice Address - State:CO
Practice Address - Zip Code:81423-0985
Practice Address - Country:US
Practice Address - Phone:970-327-4449
Practice Address - Fax:970-327-4676
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0107671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health