Healthcare Provider Details

I. General information

NPI: 1740535863
Provider Name (Legal Business Name): STEFFANNIE ROACHE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2012
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 NE 24TH ST
GRESHAM OR
97030-2905
US

IV. Provider business mailing address

6507 68TH ST NE
MARYSVILLE WA
98270-5346
US

V. Phone/Fax

Practice location:
  • Phone: 503-333-3306
  • Fax: 866-959-3177
Mailing address:
  • Phone: 971-717-2307
  • Fax: 866-959-3177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3929
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: