Individual
LAURA E ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4351 W COLLEGE AVE STE 410, APPLETON, WI 54914-3928
(800) 438-1772
(526) 234-5562
Mailing address
W175N11120 STONEWOOD DR, GERMANTOWN, WI 53022-6511
(262) 345-5533
(262) 293-9737
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10015-125
WI
101YP2500X
Professional Counselor
4101-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100081602
—
WI
Enumeration date
09/10/2018
Last updated
07/12/2022
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