Provider Demographics
NPI:1396295457
Name:ROSLAN, JADE ELISSA (LMHCA)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:ELISSA
Last Name:ROSLAN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 N 35TH ST
Mailing Address - Street 2:STE. 307
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8870
Mailing Address - Country:US
Mailing Address - Phone:206-319-5696
Mailing Address - Fax:
Practice Address - Street 1:753 N 35TH ST
Practice Address - Street 2:STE. 307
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-319-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60492383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health