Provider Demographics
NPI:1548915028
Name:ROELKE, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:ROELKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 FLINT RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-5520
Mailing Address - Country:US
Mailing Address - Phone:208-201-7049
Mailing Address - Fax:
Practice Address - Street 1:89 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5164
Practice Address - Country:US
Practice Address - Phone:208-201-7049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical