Provider Demographics
NPI:1992544860
Name:ROANE, SIMEON ANDREW II
Entity type:Individual
Prefix:
First Name:SIMEON
Middle Name:ANDREW
Last Name:ROANE
Suffix:II
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 1:19636 DERBY CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2207
Mailing Address - Country:US
Mailing Address - Phone:971-801-5264
Mailing Address - Fax:
Practice Address - Street 1:19636 DERBY CT
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2207
Practice Address - Country:US
Practice Address - Phone:971-801-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty