Provider Demographics
NPI:1730681982
Name:ROE, JULIE LYNN (PC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LYNN
Last Name:ROE
Suffix:
Gender:F
Credentials:PC
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:SHOCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:4516 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-4893
Mailing Address - Country:US
Mailing Address - Phone:513-393-2263
Mailing Address - Fax:
Practice Address - Street 1:7162 READING RD STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3899
Practice Address - Country:US
Practice Address - Phone:513-961-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200385101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1200385Medicaid