Healthcare Provider Details

I. General information

NPI: 1659294304
Provider Name (Legal Business Name): ASHLYN ERICA SHEA ROESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E PRIMROSE ST
SPRINGFIELD MO
65807-5254
US

IV. Provider business mailing address

840 E PRIMROSE ST
SPRINGFIELD MO
65807-5254
US

V. Phone/Fax

Practice location:
  • Phone: 417-324-7777
  • Fax:
Mailing address:
  • Phone: 417-324-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: