Healthcare Provider Details

I. General information

NPI: 1326760042
Provider Name (Legal Business Name): JENNIFER ROESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 6TH AVE NW
SEATTLE WA
98107-4420
US

IV. Provider business mailing address

3950 N LAKE SHORE DR # 1001A
CHICAGO IL
60613-3434
US

V. Phone/Fax

Practice location:
  • Phone: 510-858-9810
  • Fax:
Mailing address:
  • Phone: 510-858-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.LF.70021004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: