Provider Demographics
NPI:1487399135
Name:ROESCH, KATHLEEN MARY
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:ROESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 WINKWORTH PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1577
Mailing Address - Country:US
Mailing Address - Phone:315-882-1393
Mailing Address - Fax:
Practice Address - Street 1:5222 WINKWORTH PKWY
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-1577
Practice Address - Country:US
Practice Address - Phone:315-882-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist