Healthcare Provider Details

I. General information

NPI: 1700530334
Provider Name (Legal Business Name): JAMES ROFFLER BA, AAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMMERCE AVE
LONGVIEW WA
98632-3756
US

IV. Provider business mailing address

PO BOX 2394
LONGVIEW WA
98632-8455
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-5419
  • Fax: 360-200-6736
Mailing address:
  • Phone: 360-200-5419
  • Fax: 360-200-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: